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A TREATISE 



DISEASES OF THE SEXUAL SYSTEM, 



ADAPTED TO 



POPULAR INSTRUCTION. 



EDWARD H. DIXON, M. D., 

"editor of the scalpel/' 

AND 

AUTHOR OF ''WOMAN, AND HER DISEASES," 

OPERATING AND CONSULTING SURGEON. 

42 FIFTH AVENUE. 



TENTH EDITION, WITH AN APPENDIX. 

v 



New- York : 



ROBERT M. DE WITT, PUBLISHER, 
NO. 13 FRANKFORT STREET. 



■*>*•* 



Entered according to act of Congress, in tho year 18G7, 

BY ROBERT M. DE WITT, 

In the Clerk's Office of the United States District Court for the 

Southern District of Now Yoik. 



CONTENTS. 

Dedication — Preface. 

mxt *♦— stepuu*, *«• 

Chapter I. 

History of Syphilis ; its modern origin disproved ; alluded to in Levi* 
ticus, chap, xv ; and in Psalm xxxviii, Dr. Clarke's Commentary on ; 
statutes of Jane I. Queen of the Sicilies, and of Queen Elizabeth; 
true method of investigation ; author's opinion of its origin. 

Chapter II. 

Chancre defined ; first symptom ; does not always appear ; several 
kinds ; instant cure without medicine. 

Chapter III. 

Bubo defined ; second symptom ; not constant ; not always syphi- 
litic ; time and place of its appearance ; treatment — local and 
constitutional. 

Chapter IV. 

Syphilitic sore throat ; often the first constitutional symptom ; how 
distinguished from ordinary ; treatment. 

Chapter V. 
Ulcers in the nose and mouth ; mercurial swelling of the cheek ; 
treatment. 

Chapter VI. 

Eruptions of the skin and ulcers ; inutility of local without constitu- 
tional treatment. 

Chapter VII. 
Nodes and swellings of the tendons ; are they connected with mer- 
cury? treatment. 

Chapter VIII. 
Excrescences near the anus, and swellings of the testicles ; ♦reatment 

Chapter IX. 
Alopecia, or loss of hair ; physiological explanation ; treatment. 



CONTENTS. 

Chapter X. 

Blindness and deafness ; treatment difficult ; inflammation of tub. 

Chapter XI. 

Irregular and occasional symptoms ; rheumatism and ulcers ; treafr 
ment. 

Chapter XII. 
A« there any proofs that the disease is eradicated from the system f 

Chapter XIII. 

Communicable to the child before birth ; often the cause of miscar- 
riage; interesting case; great care and incredulity necessary in 
examining patients in such cases. 

Chapter XIV. 
Treatment of syphilis; secondary and tertiary symptoms; evils of 
quackery ; necessity of mercury ; accursed compounds of quacks : 
author's opinion of the action of mercury ; fumigation ; inunction ; 
internal use of. 

Chapter XV. 
On the duration of a mercurial course ; regimen to be enforced. 



JJart ££. — <*5onorrffca # 

Chapter I. 
Gonorrhea defined ; totally different from syphilis ; period of attack ; 
first symptom ; originates from other causes than contact; symp- 
toms; instant cure without medicine; often exists with syphilis ; 
may be contracted at the same time ; cases. 
Chapter II. 
Becond stage ; ardor urinse ; chordee ; injections hurtful ; treatment. 
Chapter III. 

rhird stage ; inflammation of prostate ; diognosis ; treatment ; sup- 
pression of urine ; treatment ; diagnosis from leucorrhea in female* ; 
warts on the glans. 



CONTENlo. 

Chapter IV. 
Gleet detined ; its importance ; when does it cease to be infectious T 
author's opinion ; local means o^ cure preferable ; regimen. 

Chapter V. 
Second stage; its connexion with stricture : effect on the mind ; iodide 
of iron ; introduction of bougies ; regimen ; examination of pros- 
tate ; regimen. 

Chapter VI. 
Strictures of the urethra ; sad result of quackery ; correct definition , 
always preceded by gleet ; impossibility of retaining urine ; situa- 
tion and description of strictures ; spasmodic ; the use of injec- 
tions, defended by experience and analogy. 

Chapter VII. 
Cure of strictures ; various kinds of bougies ; use of them ; cure by 
caustic ; its legitimate use defined ; great caution requisite ; author's 
invention, with plate ; not to be used as a destructive agent ; mon- 
st~^us nature of the proposition for forcing a stricture ; incision rf 
stricture; author's invention. 

Chapter VIII. 

Fistula?, or false passages in the urethra; operation for vaginal and 
rectal fistulae ; malformation of urethra, operation for ; remarkable 
case. 

Chapter IX. 

Phimosis, paraphimosis, and circumcision ; admirable custom of the 
Jews ; a great preventive of disease ; operation on the adult fre- 
quently necessary; case of; author's mode of operating. 

Chapter X. 
Swellings and other enlargement of testicle ; venereal ; treatment ; 
sarcocele ; hardening of the epydidimis ; castration ; hydrocele ; 
do. of cord ; do. encysted ; do. anasarcous ; hematocele ; great 
importance of diagnosis ; different modes of treatment. 

Chapter XJ. 
Malignant, or cancerous diseases of the testicle; fungus nematodes | 
granular fungus ; diagnosis ; operation. 



CONTENTS. 

Chapter XII. 
Varicocele, or enlargement of the veins of the cord ; diagnosis ; rarl 
ous modes of cure ; new method of the author. 

Chapter XIII. 

Cancer of the penis; do. of scrotum; sarcomatous enlargement of 
do ; imperforate vagina, operation for ; cases of author ; herma- 
phrodites explained; absurdity of such an idea; closure of the 
urethra, at birth ; polypus uteri ; instrument invented by the au 
thor, with plate; cases. 

Chapter XIV. 

Prolapsus of the vagina and womb, and leucorrhea ; causes of the 
former; utero-abdominal supporter invented by the author; leu 
corrhea always cured by caustic ; author's speculum. 

Chapter XV. 

Spermatorrhea; its causes venereal excess and onanism; causes for 
these vices ; they are tne origin o. our pnysica» mnrmity and of con- 
sumption ; copulation only designed for the production of offspring ; 
absurd desire for youthful precocity; morbid development of 
nervous system. 

Chapter XVI. 

Onanism ; derivation of word " symptoms and general physiognomy ; 
the frequent cause of phthbis ; morbid development of nervous 
system of children ; mode of address to onanists ; moral and sur- 
gical treatment ; author's caustic catheter, with plate ; author's 
speculum, with plate ; polypus ligator, do ; caustic stricture 
catheter, do 



APPENDIX. 
On the treatment of strictures by internal incision, . . 265 
Circumcision — its real object — a new method of curing semi- 
nal weakness, 272 

Abortive urethra — a new operation, . . . . .277 

The operations for varicocele, ...... 280 

Loss of virility in young married people — an unsuspected 

cause, .... 283 

Two lectures on stricture, delivered to his private class, 280 



PREFACE. 



The writer of these pages is unwilling to subject himself 
to the aspersion which will probably follow their appearance, 
without an explanation of the motives that induced him to 
prepare them; and as those who censure often doubt the 
statements of such as incur their animadversion, he hopes bv 
the nature and distinctness of an avowal rarely made by 
authors, as well as the internal evidence of the book itself, to 
obtain full credit for what he is about to say. 

In the first place then, the motive is self-interest. The 
author has long been urged by numerous professional 
friends as well as patients, to publish such a book. Both, 
smarting under the influence of licensed and other quack- 
ery, have assured him that it would be approved by intelligent 
professional and other men. This, not only from conviction 
of the candour of his friends, but extensive personal observa- 
tion, he believes. A diversified practice of fifteen years' du- 
ration, with a minute and comprehensive knowledge of the 
medical policy of the day, has entirely convinced him that the 
most effective causes are operating, to break down the slender 
barrier hitherto existing, between the accomplished surgeon 
and the vilest empyric. This has long rested on a foundation 
as feeble as the public intelligence on medical subjects, and 
the only wonder is, that it has so long withstood the on- 
slaught : the late act of the legislature is the legitimate se- 
quence of its own miserable policy, in granting to colleges 
monopolies to teach, or rather to huckster diplomas. 

The profession is now open to all : — yes, so far as the fos- 
tering care of that great " caterer and dry nurse of the state *' 



X PREFACC. 

an American egislature can extend its maternal arrriS, th« 
most profound of our number may enter the lists for public 
favor, with his boot black. This kind protection of the pub- 
lic health, was absolutely a necessary appendage to their pre- 
vious enlightened act ; for these colleges, alas for poor hu- 
manity, have been animated with such persevering zeal for the 
numerical, not the intellectual strength of their graduates, 
(upon the yearly number of whom the subsistence of many of 
their professors entirely depends,) that the country is flooded 
by men totally destitute either by education or habits of philo- 
sophic thought, for the profession to which they have so un- 
happily been admitted. 

This has gradually destroyed the only perceptible difference 
between the physician and the patient : for although a spe- 
cious and bland exterior, or as Bacon hath it, " a person ex- 
cellently well qualified for artifice in general," will do much 
to ensure respect, still the absence of a thorough education, 
will in a protracted and difficult case, often convince the at- 
tendant that it is unwise to make indefinite calculations upon 
the stupidity of his patient ; he will eventually require an 
explanation of his treatment, which however incompetent to 
understand, he will so much the more pertinaciously demand 
From a deficiency in the medical education of his attendant, 
this may be difficult ; to a person thus situated, we say in all 
candour, possess yourself of this little book ; 'twill give the 
necessary information, and make your patient tractable ; whilst 
you go home and consult some of those great authors you 
would have been obliged to study, had you been properly edu- 
cated ; and for fear the patient should discover your motive 
should you present him with the volume, tear out nicely this 
preface, and leave the blank leaves that intervene expressly 
for this purpose. So much for interest ; and it will be seen 
we anticipate an extensive sale. 

In addition to a description of numerous delicate and dis- 
tressing affections to which we are all liable, and which require 



PREFACE. XI 

the utmost nicety of discrimination and treatment, we have 
attempted to show how the very sources of its earliest exist- 
ence in its mother's womb, are impressed by the vices of its 
parents ; and to trace the web of error that is wound round 
the nervous system of the little infant, even from the pure 
fountain of maternal love, till having entered the " dark la- 
byrinth of sin," he presents himself to the surgeon, a fellow- 
being of ungoverned passion, with his very life-blood sapped 
»n the citadel ; he has imbibed 

" The leperous distilment; whose effect 
Holds such an enmity with blood of man, 
That, swift as quicksilver, it courses through 
The natural gates and alleys of the body — 
Curdling like eager droppings into milk, 
The thin and wholesome blood." 

And it his duty to give the patient the benefit of his hearty 
sympathy, and all the aid that modern science can afford 
The reader cannot fail to perceive that the whole object o* 
the book is to prevent the folly of an attempt at self-treat- 
ment. Surely, if we have been successful in enumerating 
half the legitimate consequences of the affection, none but a 
madman would attempt to tamper with himself. 

We have spoken at length on the primary symptoms, be- 
cause it is in that stage that he is most susceptile of scientific 
treatment. Alas ! how often does he present himself in the 
loathsome condition of secondary disease, when perhaps, the 
merciless ignorance of quackery has exhausted itself upon 
him, and he becomes conscious of his credulity. How often 
at a period of life when the glad heart leaps at the very con- 
sciousness of existence, and he beholds his companions buoy- 
ant with hope and the elastic energy of youth, surrounded 
with all the endearments of conjugal and parental love, — the 
sweet smile of infantile innocence lisping the name of father 
—mother ; — his melancholy condition of disease and decay 
ehfte its subduing influence on the spirit, and he awakes to 
hi *ue condition. Well did David exclaim, " There is no 



XU PREFACE. 

soundness in my flesh because of thine anger." " My heart 
panteth, my strength faileth, as for the light of mine eyes it 
is gone out from me." 

Under such emotions, it was once the sad fortune of the 
writer to witness the death of a noble young man by his owp 
hand ; the symptoms, after repeated affections had become 
utterly unmanageable, and his physician a most amiable and 
skilful man, told but too plainly by his countenance his lost 
hope ; he seized a razor and severed both the jugulars, ere his 
hand could be arrested or even his purpose known, thus end- 
ing his sorrows in the grave, where the light of hope and 
life had nearly expired together. 

It is from despair like thi6 that the humane surgeon is to 
rescue the victim of passion, and it is his duty to prevent the 
soul-sickening anguish of many a mother's heart, ere it be- 
come her sad fate to reflect, that her unborn babe is poisoned 
in the secret springs of its existence, and, instead of the in- 
vocation for its safety, her prayer shall be that its death may 
be granted her as the most merciful boon of Heaven. It is 
indeed often the case that the surgeon is called to treat disease 
of this very character in the bosom of domestic life, where 
all around gives evidence of happiness : alas, 

"That lust, thougli to a radiant angel linked, 
Will sate itself in a celestial bed 
And prey on garbage." 

Yet this is one of the many pages of life presented to us, 
and, whilst we cannot prevent the melancholy fact, let us ap- 
ply our best efforts for the removal of the consequence : how- 
far this will assist the profession is yet to be seen. The wri- 
ter will only add, that though their approbation will be 
agreeable, treir censure will not distress him. 



CHAPTER I. 



HISTORY OF SYPHILIS. 



There are so many points of interest connected wilh 
the history of syphilis, not only to the physician and 
general reader, but also in a medico-legal point of view, 
that I shall offer no apology for the length of the first 
chapter, but my regrets that it has not been done in a 
more acceptable manner. 

The reasoning advanced on its origin, is in accordance 
with principles recognized by some of the highest names 
in our profession. Not only bibliography, but facts 
and analogy, tend to confirm it; and although the 
idea of there being constantly entire new points for its 
origination, by means of morbid secretions, would 
seem to favour the belief that both the varieties of 
venereal, syphilis and gonorrhea, might occasionally 
merge into each other, as was supposed by Mr. Hun- 
ter, and involve the treatment in obscurity, still, I 
apprehend no such result in the hands of judicious prac« 
titioners. Neither is it likely that this volume will be 
read by them, if perchance it should not be entirely con- 
demned from opposition to popular instruction. The 
writer well knows, and long himself held the same doc- 
trine, that by no possibility could the people be inform- 
ed on medical subjects. Increased knowledge of men 
and things has taught him better, and he now sincerely 
believes, that the blasting influence of quackery might 
1 



2 HISTORY OF SYPHILIS. 

long since have been checked, had the profession devot 
ed half the effort they have made, in instructing the pub 
lie, rather than opposing them. 

The importance of the subject of the occasional re- 
origination of syphilis, is very great ; and although I 
certainly have nev^er met with a case, in which I had 
reason to believe this has occurred in syphilis, I can by 
no means say the same of gonorrhea, for I firmly be- 
lieve I have, and by parity of reasoning, on syphilis, a 
like result will follow. 

Although ulcers of the genital organs are mentioned 
in Hyppocrates and other ancient writers, the Bible fur- 
nishes us with the first written assurance of syphilis ; 
and it is very evident that Moses, that profound legisla- 
tor and physiologist, well knew its nature ; see Levi- 
ticus, chapter xv. — 

44 1. And the Lord spake unto Moses and to Aaron, 
saying, 

" 2. Speak unto the children of Israel, and say unto 
them, When any man hath a running issue out of his 
flesh, because of his issue; he is unclean. 

"3. And this shall be his uncleanness in his issue; 
whether his flesh run with his issue, or his flesh be 
stopped from his issue, it is his uncleanness. 

44 4. Every bed whereon he lieth that hath the issue, 
is unclean ; and everything whereon he sitteth, shall 
be unclean. 

44 5. And whosoever toucheth his bed, shall wash his 
clothes, and bathe himself in water, and be unclean un- 
til even. 

44 6. And he that sitteth on any thing whereon he sat 



HISTORY OF SYPHILIS. 3 

that hath the issue, shall wash his clothes, and bathe 
himself in water, and be unclean until even." 

The rest of this chapter is devoted to an explana- 
tion of the necessary ablutions and offerings to be made 
by the male, and female ; for in verse xix. we have a 
similar injunction for her, viz. " If a woman have an 
issue, and her issue in her flesh be blood, she shall be^ 
put apart seven days ; and whosoever toucheth her 
shall be unclean until the even." Then follow still 
more emphatic commands respecting the menstrual 
period, to which, there is no doubt, the preceding injunc- 
tion refers — vers^ xxiv. to which we refer the reader, pre- 
ferring to add, in its place, the commentary of the learn- 
ed Dr. Adam Clarke, — see Commentary on the 15th 
chapter of Leviticus. " W hen any man hath a running 
issue," &c. " The cases of natural uncleanness, both of 
men and women, mentioned in this chapter, taken in a 
theological point of view, are not of sufficient impor- 
tance to us to render a particular description necessary, 
the letter of the text being, in general, plain enough. 
The disease mentioned in the former part of this chap- 
ter, appears to some to have been either the consequence 
of a very bad affection, or of some criminal indulgence ; 
for they find that it might be communicated in a variety 
of ways, which they imagine are here distinctly speci- 
fied. On this ground, the person was declared unclean, 
and all commerce and communion with him strictly 
forbidden. The septuagint renders " ha-zab," the man 
with the issue, by o yovoggvrjs, the man with a gonorrhea, 
no less than nine times in this chapter, and that it means, 
what, in the present day, is commonly understood by 



4 HISTORY OF SYrHILIS. 

that disorder, taken not only in its mild, but in its worst 
sense, they think there is little room to doubt. Hence 
they infer, that a disease which is supposed to be com- 
paratively recent in Europe, has existed almost from 
time immemorial in the Asiatic countries ; and that it 
ever has been, in certain measures, what it is now ; and 
that it ever must be the effect of sensual indulgence, 
and illicit and extravagant intercourse between the sexes. 
The disgraceful disorder referred to here, is a foul blot 
which the justice of God, in the course of providence, 
has made, in general, the inseparable consequent of these 
criminal indulgences, and serves, in some measure, to 
correct and restrain the vice itself. In countries where 
public prostitution was permitted, where even it was a 
religious ceremony among those who were idolaters, 
this disease must have been frequent and prevalent. 
When the pollutions and libertinism of former times are 
considered, it seems rather strange that medical men 
should have adopted the opinion, and consumed so much 
time in endeavouring to prove it, viz. that the disease is 
modern. It must have existed, in a certain measure, 
ever since prostitution prevailed in the world ; and this 
has been in every nation of the earth, from the earliest 
era. That the Israelites might have received it from the 
Egyptians, and that it must, through the Baal-peor and 
Ashteroth abominations, which they learned and prac- 
tised, have prevailed among the Moabites, &c, there 
can be little reason to doubt. Supposing this disease to 
be at all hinted at here, the laws and ordinances enjoin- 
ed were at once wisely and graciously calculated to re- 
move and prevent it. By contact, contagion of every 



HISTORY OP SYPHILIS. 5 

kind is readily communicated ; and to keep the whole 
from the diseased, must be essential to the check and 
eradication of a contagious disorder. This was the 
wise and grand object of this most enlightened legisla- 
tor, in the ordinances which he lays down in this chap- 
ter. I grant, however, that it was probably of a milder 
kind in ancient times ; that it has gained strength and 
virulence by continuance ; and that, associated with 
some foreign causes, it became greatly exacerbated in 
Europe about 1493, the time in which some have sup- 
posed it fir«t began, though there are strong evidences 
of its existence in this country ever since the eleventh 
century." So far Dr. Clarke's learned commentary on 
this interesting matter, we have no doubt, will very sa- 
tisfactorily precede any ideas of our own ; and as it is 
more than probable our use of his commentary, as well 
as his own explanation, will be condemned by well- 
meaning, though prejudiced readers, we think it right 
to give the full benefit of all existing light on our sub- 
ject to be derived from the Bible ; we shall therefore 
continue our reference to that work. 

The ordinance so wisely promulgated by Moses, dates 
as early as 1400 B. C. More than five hundred years 
later, the xxxviii. Psalm was written, on which we find 
the following expressive announcement by Dr. Clarke, 
vide his Commentary : — " Several conjectures have 
been made relative to the occasion on which this Psalm 
was composed ; but it does not appear that, out of all 
the titles given it, we can gather the true intent of the 
Psalm : the most likely is, that it was in reference to 
some severe affliction which David had, after his illicit 
1* 



HISTORY OP SYPHILIS. 

commerce with Bathsheba ; but of what nature we are 
left to conjecture from the third, fifth, and seventh 
verses." 

There can be little doubt that Bathsheba, from her 
willingness to assent to David's propositions, was a per- 
son who valued her virtue very lightly, notwithstanding 
the possession of a husband, of so many graces, and 
such distinguished valor. The exposure of her person, 
whilst bathing, to the public gaze, (to what extent we 
are not informed, though it seems it attracted the notice 
of David from the roof of his house,) was sufficient 
evidence of her lightness of character, and the proba- 
bility of her being affected with venereal. The Psalm 
is dated, B. C. 1034, not quite one year after the dis- 
graceful act, or enough for the developement of syphilis 
in its worst form. 

" 3. There is no soundness in my flesh because of 
thine anger ; neither is there any rest in my bones be- 
cause of my sin." 

Pain in the bones, or rather, as the reader will see 
in the symptoms of secondary syphilis, in their invest- 
ing membranes, and the deeper ligamentous structures 
of the body generally, is common in syphilis. Dr. 
Clarke remarks, " This seems to refer to some disorder 
which so affected his muscles as to produce sores and 
ulcers." 

" 5. My wounds stink and are corrupt, because of my 
foolishness." 

" Taking this in connexion with the rest of this 
Psalm, I do not see that we can understand the word 
in pny figurative or metaphorical way. I believe they 



HISTORY OP SYPHILIS. 7 

refer to some disease with which he was at this time 
afflicted: but whether the leprosy, the small-pox, or 
some other disorder that had attacked the whole sys 
tern, and showed its virulence on the different parts of 
the surface, cannot be absolutely determined. 

" 7. For my loins are filled with a loathsome disease : 
and there is no soundness in my flesh." 

Dr. Clarke — " Or, rather, a burning; nikelah, from 
kalah, to fry, scorch, &c. ; hence nikelah, a burning or 
strongly feverish disease." 

" 10. My heart panteth, my strength faileth me : as 
for the light of mine eyes, it is also gone from me." 

" There is no soundness in my flesh." — "All without 
and all within bears evidence that the whole of my sol- 
ids and fluids are corrupt." 

" 11. My lovers and my friends stand aloof from my 
sore; and my kinsmen stand afar off." 

" For fear of being infected by my disease." 
It would certainly be difficult for the most eloquent 
and observing physician, to describe the secondary symp- 
toms of an aggravated case of syphilis, with more 
graplnjp earnestness, than is here set forth. It had not 
only affected the entire circulating system, but even the 
eyes, with some one of the three principal varieties of 
inflammation of that organ. See chapter x. 

To the unbiased mind, there can be no reasonable 
doubt that the above quotations allude to syphilis ; and 
we think Dr. Clarke*s Commentary conclusive. More- 
over, when we come to treat of some other diseases of the 
penis, we shall show conclusively, that the enlightened 
and humane right of circumcision, in connection with 



O HISTORY OF SYPHILIS. 

proper ablutic/i, so often and forcibly enjoined by Scrip* 
ture, is the most efficient way to prevent the occurrence 
of the disease. 

Hyppocrates, who lived 460 B. C, describes ulcers 
of the genital organs of both sexes, as of frequent oc- 
currence. Now, though these were not called syphilitic, 
their frequent occurrence in so suspicious a locality, is 
evidence enough of their contagious character. A host 
of writers follow, who describe so many ulcers affecting 
these parts, that it is really difficult to conceive what use 
writers could assign these organs, that rendered them so 
peculiarly unfortunate, who try to support the idea of 
its modern origin. 

A very curious document is preserved, from the stat- 
utes of Jane I., Queen of both the Sicilies, respecting 
the regulation of the public stews of Avignon, in 1347. 
W° cannot withhold our approbation from the truly 
kind and philosophic attention of her majesty to the 
welfare of her subjects, however her delicacy may be 
questioned. The document is as follows : — " The 
Queen commands, that on every Saturday the women 
of the house be singly examined by the abbess, and a 
surgeon, appointed for that purpose by the directors, 
and if any of them have contracted any illness by their 
whoring, that they should be separated from the rest, 
and not suffered to prostitute themselves, for fear the 
youth who have to di with them catch their distem- 
pers." 

Queen Elizabeth, who found, if report, say true,' a 
peculiar use for the finest of her male subjects, despite 
a proper attention to maidenly decorum, made the 



HISTORY OF SYPHILIS. 9 

enactment, " that every male in her train of attendants, 
who had a running from the pentle, should pay into the 
public treasury forty shillings." 

About the year 1500, a writer, Benedict Victorius, 
advanced some curious views, to the correctness of 
which the more astute philosophy of the present day 
would find it rather difficult to assent, viz. that the vene- 
real disease was epidemic, and originated, in his own 
words, " from an unwholesome disposition in the air," 
and " a spontaneous corruption of the humors, contract- 
ed by an error in diet, or the abuse of the non-naturals." 
This writer seems, moreover, to have found it necessa- 
ry to defend la belle France, from a mischievous impu- 
tation, by the English, of having originated it, by their 
wickedly calling it Morbus Gallicus. He produced an 
elaborate essay, going to prove that the state of the air, 
together with that of the putrid humors, is sufficient to 
produce it ; and to put the matter beyond all doubt, he 
testifies that he happened to know " some very worthy 
and religious nuns, who were confined in the strictest 
manner, unfortunately contract the disease, from the pe- 
culiar state of the air, together with that of the putrid 
humors, and the weakness of their habit of body." This 
doctrine, though at the present day we smile at its ab- 
surdity, was really not only believed, but stoutly defend- 
ed by physicians, many of whom being monks, and of 
course immaculate, and having access to nunneries, 
may have had some private reasons for then* pertinacious 
adherence to their own tenets. 

In 1496, the French, who had no such reasons, so 
far believed this absurdity, as to pass an edict, that all 



10 HISTORY OF SYPHILIS. 

who had venereal, on pain of death, should be pro- 
hibited from conversing with the rest of the world, and 
retire to St. Germains, to places set apart for that pur- 
pose.* Nevertheless we find certain sagacious old 
doctors, in England, as Jate as 1380, who give reason 
to suppose, by their treatment, that they had no views 
grounded on the innocence of the nuns. They went 
at it in a workmanlike way, and cured up their patients, 
secundem artem, paying very little attention to the 
agency of the air, or the non-naturals. About the same 
period, a very learned Latin author, John Gadisse3, 
gives ample proof that he knew of its contagious na- 
ture, and was very successful in its treatment. 

Without dwelling longer on the history of the dis- 
ease, I will merely remark, that after long disputes 
about its identity with leprosy, its originating in Amer- 
ica, and being brought to England by Columbus's sai- 
lors, the peculiar kind of venereal found, on the discov- 
ery of this country, in Canada, the Sivvens of Scot- 
land, the Yaws of Africa, the Judham of the Jews, 
and the Venereal of Norway, — it was reserved for the 
genius of the English, to investigate this subject philos- 
ophically, by directing their attention to the general 
jaws of the diseases of that peculiar membrane, called 
mucous, that lines the genital organs of both sexes 
That this is the only philosophic plan of investigating 
the nature of the disease, is evident, not only from the 
absurdity of supposing a single point of the whole 

* This edict related to the disease that hroke out during the siege 
of Naples. Now there is great doubt if this was actually syphilis, a» 
the reader will see directly that it was communicated without contact. 



HISTORY OF SYPHILIS. II 

earth's surface for its origin, when the genital organs, 
being of similar structure and functions, must inevita- 
bly have been affected with similar general diseases, 
throughout the world ; and if the general results of in- 
flammation, for example, were the same, why not the 
individual one in question, or the secretion of a spe- 
cific poison, from similar, though inappreciable causes. 
See, for one moment, what forcible analogies may be 
found ; — the specific virus of a mad dog's saliva, inva- 
riably produces similar results all over the world ; and 
yet it is constantly originating, de novo. "Why ! those 
who would have a single point of origin — as from 
America — might as well assert that all rabid dogs were 
in turn bitten by each other, and that the necessary an- 
tecedent to hydrophobia, was to be from some one indi- 
vidual of the species. Yet this would be deemed an 
absurdity. Moreover, the reader will see the various 
effects produced upon different constitutions by the 
same virus; and, as it has always been known that the 
secretions even of healthy individuals, have their essen- 
tial .differences, (the dog even distinguishing the smell 
of his own master,) is it not a fair inference, that dis 
ease would produce equal changes in the secretions of 
the private parts, and that these secretions might, when 
united with others, become specific. 

Again, it is well known, in the various modifications 
of Leucorrhea — a disease to which the most virtuous 
females are subject — under this same law, from the 
most simple state, this very disease will pass into the 
most virulent and distressing one, producing great irri- 
tation and offensive discharge, and often affecting 1 theii 



12 



HISTORY OF SYPHILIS. 



legal partners with every symptom of gonorhrea. It 
has always been known that anatomists, cooks, and 
butchers, have been subject to severe and often fatal af- 
fections from vitiated animal decomposition ; and this 
again is another forcible analogy, affording the strong- 
est reasons for our conclusion, taken in conjunction 
with the disgusting want of cleanliness about the geni- 
tal organs, so universal amongst a very large portion of 
the human race. 

The writer would not be misunderstood on this im- 
portant point. The object is to convince the reader, that 
there must bave been, and by the same mode of reasoning 
still are, and will continue to be, (however rarely,) entire 
new points of origin, somewhere upon the extensive sur- 
face of this earth. He is perfectly aware of, and will soon 
show from the investigations of Hunter and Ricord es- 
pecially, (for to them, almost exclusively, belongs the 
credit of rigid experiment and induction,) that the form 
of venereal productive of the most serious constitution- 
al mischief, is the result of a primary sore, to which has 
been applied, from its first observer, the term Hunteri- 
an Chancre ; and that this is almost universally suc- 
ceeded by a characteristic eruption over the body. Mr 
Carmicliael, a very distinguished and philosophical sur 
geon, published a work in Loudon, in 1825, on the plu- 
rality of venereal poisons. Although he believes the 
disease now recognized as syphilis, to have been first 
brought to England by Columbus's sailors, still he as- 
serts, as we also have endeavoured to show, that vene- 
real diseases, " strongly resembling the imported one," 
bave existed for three centuries, and been, from their 



HISTORY OF SYPHILIS. 13 

marked resemblance, confounded with it. Mr. Samuel 
Cooper, in his surgical dictionary, (a work of the high- 
est authority,) remarks, that the army of Charles VIII. 
at the conquest of Naples, in 1494-5, were afflicted 
with a supposed venereal disease, " that spread with un- 
exampled rapidity and virulence." 

There is a decree of the parliament of Paris, dated 
1496, in which this disease is mentioned as having ex- 
isted two years ; and as it is said to have spread " with 
such unexampled rapidity," in that period, and more- 
over to have been communicated merely " by the touch, 
residence in the same chamber," &c, it could never 
have been ordinary venereal. Indeed, Mr. Cooper also 
remarks, " unless some other mode besides coition be 
supposed, its extension throughout Europe in two years, 
would imply a depravity of manners quite unexampled, 
and beyond all credibility." 

As we find about ihis period, however, the attention 
of writers strongly directed to its investigation, it seems 
fair to infer that it had undergone some important 
change — perhaps in virulence. Above all other data, 
however, must be placed the introduction of mercury 
in its cure. This took place in 1516. See Cooper. 
As this is the nearest approach to a specific, it must, in 
the absence of a better mode, which certainly did not 
then exist, have been the surest way to determine what 
was, and what wis not, specifically syphilitic. 
2 



CHAPTER II. 



CHANCRE. 



The term venereal disease, we shall not employ, as 
that would imply any disease following coition ; nor 
shall we, in this chapter, say a word of gonorrhea or 
clap, as that is, beyond all doubt, a local disease, that 
cannot permanently affect the constitution ; although 
its distressing, and often permanent effects, when neg- 
lected, will be sufficiently apparent when we treat on 
that subject. 

The term syphilis, is derived from the Greek ot^xoj, 
filthy, and is the one mostly in use by physicians. Pox, 
is the vulgar term. The first question, and the most im- 
portant to be determined is, what is the most uniform 
and unvarying symptom by which we shall know when 
a person has contracted syphilis ? Undoubtedly, the 
appearance of an ulcer on the genital organs. But 
this ulcer is not always visible, either in the male or fe- 
male ; neither is it always syphilitic ; and, lastly, there 
are very rare, though occasional cases, in which the dis- 
ease is communicated, without any ulceration whatever, 
or any visible external sign, and in which the first evi- 
dence we have of any venereal disease, is the appear- 
ance of a bubo in the groin ; and even this itself ha3 
been known not to occur, or to pass away without be- 



CHANCRE. 15 

ing noticed by the patient, and no alarm has been ex- 
cited until syphilitic sore throat, and an eruption over 
the skin, has induced the patient to call in advice. 

These, we repeat, are rare cases ; yet they constitute 
examples, occasionally submitted to the notice of every 
experienced practitioner. The order in which spyhilit- 
ic symptoms appear, if not stopped by treatment, is as 
follows : — Chancre, bubo, ulcers and inflammation in 
the throat, mouth and nose, eruptions on the body, 
nodes or hard swellings over the joints, tendons, and 
bones, excrescences about the arms, swellings of the 
testicles, loss of hair, blindness, and loss of hearing. 

The term Chancre, was first applied by the French, 
from xapxtvos, venereal cancer, from its tendency to 
corrode. It is only applied to the primitive sore — all 
others that appear on the body generally being called 
constitutional eruptions. The matter of syphilis must 
be directly applied in order to produce it. It is said by 
medical authors, and practice seems to warrant the ob- 
servation, that, although the chancre may appear, and 
usually does, in a few days after an unfortunate con 
nection, six weeks, and even several months, may elapse* 
before it appears. A gentleman, in the practice of the 
writer, was two months on the voyage to Canton be- 
fore the chancre appeared, though there was no possi 
bility of an infection on board. In these instances, 
there is no doubt that the virus has produced its specific 
effect — some inexplicable change in the constitution 
preventing its development. 

Although, from obvious reasons, the chancre usually 
appears on the penis, especially on the end or glans, as 



.16 CHANCRE. 

it is called, still it is not confined to this part. It may- 
appear on any part of the body where the virus touch- 
es. Thus we have it on the lips from kissing, the poi- 
son having been conveyed there from the fingers ; on 
the nipples of the nurse, from the child, who has been 
affected in passing through the private parts of the 
mother, or derived it from the blood of the parents.* And 
on the thighs and lower parts of the body, generally 
from the discharge conveyed there by its contiguity to 
the penis. There may be one or more. In females there 
are frequently considerable numbers, or many running 
together. They are not always visible, but may exist 
within the vagina, and even on the neck of the womb, 
and in the male within the urethra. These latter are 
often the cause of great errors on the part of the patient 
and practitioner, as they will go on and produce exten- 
sive trouble — the patient supposing he has only gonorr- 
hea. 

The amount of discharge is variable, both in appear- 
ance and quantity. At first it is scarcely visible, so 
small is the ulcer. When more advanced, it is gene- 
rally thin, greenish, and tinged with red. The impor- 
tance of distinguishing a chancre from other sores to 
which the penis is liable, is very great. If it should 
not be a clinncre, or specific as physicians often say, 
mercury is not only unnecessary, but often injurious. 
The injury often done by mercury is immense, in the 
nands of inexperienced persons, who, falsely concluding 

* There is strong reason to believe that when the mucous mem 
branes are affected with secondary symptoms, they have the same 
power of inoculating as chancres. 



CHANCRE. 17 

that every ulcer following coition is syphilitic, immedi- 
ately administer it as a cure-all. 

In by far the greater number of cases, chancre ap- 
pears a few days after coition in the form of a small cir- 
cumscribed ulcer, no larger than half a buck-shot. It 
almost invariably presents a sensation of hardness to 
the feel, other ulcers being soft. It often has a raised 
edge. This is called the Hunterian chancre. If a 
patient present himself to a surgeon with a sore thus 
characterized, within five days from its first appearance, 
the disease admits of being checked at once, without 
the necessity of a particle of medicine. 

It is a remark of the distinguished Ricord, that if this fact 
were well known, syphilis would be disarmed of its ter- 
rors. Yet the disease often proceeds to the formation of a 
a bubo. Now this is, in far the greater number of cases, 
the inevitable result, and thus it happens: the surgeon 
yields to the patient's fear of an instrument, and hopes to 
subdue it by caustic, — a method infinitely more painful. 
The caustic, for the same reason, (the fear of pain,) is 
only partially applied, and serves, by extending inflam- 
mation, to excite absorption of the poison, and the con- 
sequent production of a bubo; after which, unlessmercury 
be employed, constitutional symptoms are almost certain. 
The proper method is to excise it with scissors. This 
is done in an instant, by means of a small forceps, so 
constructed as to grasp the base of the ulcer ; then 
raising it up, a single clip of the curved scissors removes 
it at once, and with it all apprehension may vanish. 
We would urge this upon the reader with the greatest 
earnestness, well knowing its value in a great number 



18 CHANCRE. 

of cases. Indeed, so highly do we esteem it, that we 
are not circumscribed by time, and have often done it 
with success after the fifth day, and when there was 
every reason to suppose, from the pain felt in the groin, 
a bubo was forming — nay, it has formed ; and then, by 
its sudden subsidence, proved that it was only the result 
of irritation, preparatory to absorption of the poison. 
In the next chapter bubo will be fully explained. 

This is the proper mode of treating all chancres 
whose characteristics are so marked and extent so 
limited, as to admit of no doubt as to their real nature. 
Fortunately, as we have said, these are the most fre- 
quent, yet they often present aspects of so different a 
nature, and are so extensive, as, for instance, when 
several run together, that the patient either refuses to 
allow, or the surgeon is unwilling to excise them. In 
all these cases, the thorough application of caustic is 
the remedy. Mercury is not to be thought of, so long 
as there is a possibility of stopping the disease at once. 
Chancres occasionally present the appearance of a rais- 
ed vesicular character, and are filled with thin serous 
fluid. These are often too extensive to be cut out. 
They should be ruptured and instantly well washed 
with a large quantity of water, so as to prevent the con- 
tents from affecting any other portion of the penis. 
They must then be well cauterized with the nitrate 
of silver, till they are quite white, and dressed with dry 
lint only. Examine them on the second day, and if the 
surface is not thoroughly altered, apply the caustic 
again. When the sore presents a healthy granulated 
appearance, dress it with dry lint till healed. No greasy 



CHANCRE. 19 

applications whatever are admissible, whether mercurial 
or otherwise. 

I shall describe the three other appearances that 
chancres commonly assume, as I am well assured of 
the interest with which they are viewed by the consci- 
entious though, perhaps, inexperienced physician, and 
his unwillingness to submit his patient to a protracted 
mercurial course, for a sore that requires nothing but 
simple treatment. 

The phagedenic , or sloughing ulcer , though it origin- 
ates in a manner either similar, or nearly so, to the pre- 
ceding, in a day or two assumes an alarming appear- 
ance. It derives its name from $aya>, to eat. It eats 
away the skin, and should it happen to exist on the 
smooth surface, or glans of the penis, it may in a few 
days burrow so deeply as to attack the deep and vascu- 
lar structure, when the most alarming flow of blood may 
be the consequence. It has been often noticed, (and 
here is an irresistible proof that there are essential 
differences in the original poison,) that several individ- 
uals will be affected with this ulcer from the same wo- 
man. The ulcer is characterized by great irregularity 
of shape and depth, being ragged in its circumference, 
often very painful, and covered with a greyish and thin 
coating over its surface ; its discharge is bloody, from 
the numerous small vessels it so rapidly destroys, but 
its natural ulcerous secretion is thin and unhealthful, 
being the reverse of pus or matter which is bland and 
cream-like. Both local and general treatment are ne- 
cessary. The best surgeons frequently attempt to alter 
the action, as in common chancre, by caustic, the nitric 



20 



CHANCRE. 



acid, &c. As constitutional treatment is invariably ne- 
cessary, and it would evidently conduce to the worst 
results to tamper with so alarming a case, I shall only 
suggest to the patient to avail himself of the best surgi- 
cal aid within reach, and to avoid all domestic or friendly 
prescriptions, as he values his penis. 

The next variety of chancre, and the one we most 
frequently meet with after the first described, (the pha- 
gedenic fortunately being more rare,) is called the irrita- 
ble apthous chancre. It is so named from its resem- 
blance to the small ulcers of a whitish colour that often 
form in the mouth. Every person has had these annoy- 
ing companions at one time or other, about the lips and 
on the side of the tongue, where they originate some- 
times from cold, and oftener from derangement of the 
stomach, and are called apthae by physicians. Though 
perfectly simple in character, often disappearing without 
any treatment, they so closely resemble the chancre 
above mentioned as to give it a very appropriate name. 
This resemblance, doubtless, depends upon their situa- 
tion, and the precisely similar nature of the skin covering 
the glans or head of the penis, to the mucous membrane 
of the mouth ; both the apthae and the chancres being 
directly under the delicate cuticle, or, as it is called, 
the scarf skin. 

This chancre is accompanied with itching, and is 
often of so slow a progress, that it does not excite the 
alarm of the patient, till some slight exposure or consti- 
tutional derangement, lights up an action, — the poison 
is absorbed, and bubo is produced. I have known 
them, no larger than a pin-head, remaining an entire 



CHANCRE. 21 

month in a torpid state, and then, even without a bubo, 
causing a profuse constitutional eruption, and the great- 
est distress and mortification to the patient, who, ima- 
gining himself quite secure, and not dreaming of the 
least harm from the insignificant ulcer, had unwisely 
negle-cted to seek advice. These chancres admit of the 
same treatment as those first described. Like them, 
they can be cut short in the beginning, if decisive mea- 
sures be taken ; and like them, be followed by the same 
constitutional symptoms if neglected. 

Like all other chancres, the later the patient applies for 
advice, the more likely he is, either to be subjected to the 
mercurial course, or to have the constitutional eruption. 
Nor can the surgeon, as I know by experience, even 
should the patient apply as early as the tenth day, assure 
him, in all cases, that he will not be overtaken by general 
eruption, as I have had this happen directly to myself, as 
well as under my notice in the practice of a friend dis- 
tingushed for his skill in the treatment of syphilis. Nei- 
ther my own nor my friend's patient having ever before 
had the disease, both having been under the same care 
for many years, for which reason we were perfectly will- 
ing to believe them. Neither of our patients had bubos. 

It would seem from the description of Mr. How- 
ard, a distinguished British writer, that there is a va- 
riety of this chancre which he terms " the livid irrita- 
ble chancre." He describes it as follows : " From the 
ginning, painful to the touch, instead of the apthous, it 
has a livid or blackish hue, with a corroded surface, and 
hollow ragged edges. It creeps on at a great rate, eat- 
ing away and undermining the surrounding skin irregu- 



92 CHANCRE 

larly, like a small spreading phagedenic sore. It is 
attended from the beginning with much more discharge 
than the preceding species, and that discharge seems to 
be highly acrimonious. Bubo comes on much sooner 
in this than the preceding species of chancre." Mr. 
Howard describes several species of this ulcer, all of 
which we have taken the liberty to append as varieties 
to the apthous chancre, believing them to depend exclu- 
sively upon the different constitutions of those affected. 
Our object in the present work, indeed, is to simplify to 
the non-medical observer, as far as possible, a subject 
involved by writers in great perplexity, and to enable 
the afflicted to form a rational judgment on the nature 
of his affection. 

The fourth and last variety of chancre, is one that has 
been the cause of more disappointment, both to the pa- 
tient and practitioner, than any of the others. By its 
want of resemblance to either of the other varieties, and 
its complete similitude to an occasional effect of gon- 
orrhea, it produces either a false security, or a 
temporising treatment, till the appearance of a bubo 
settles the question, and the patient is necessarily sub- 
mitted to a mercurial course. It is called the chancrous 
excoriation of the glans penis. It consists of an infinite 
number of small chancres or papilla, that approximate 
so closely as to form the appearance of a removal of the 
skin, or raw surface, which soon degenerates into an ex- 
tensive ulcer, that looks as though the surface was covered 
with starch or paste. There are, however, varieties of 
this excoriation from other causes ; as, for instance, 
where due attention to cleanliness has not been paid, 



CHANCRE. ^3 

and the ordinary white discharge, where the foreskin 
covers the glans, has been suffered to remain and be- 
come corrupt. These affections will be noticed in the 
chapter on gonorrhea. The same treatment is here 
applicable as to other chancres. The affection is far 
from infrequent, and I am satisfied that patients have 
often been saved from a prolonged mercurial course, by 
the proper application being made to them, with suffi- 
cient decision, to destroy their specific action. 

These are the ordinary forms in which primary sy- 
philis presents itself to the surgeon. There certainly is 
very considerable difference in their occasional appear- 
ance ; yet, as they all produce constitutional eruptions, 
and other symptoms of greater or less severity, and we 
sincerely think are capable of rapid cure in their inci- 
piency, they are sufficiently described to give the reader 
a general idea of the kind of affection for which he 
should seek medical aid. Yet, when we reflect that the 
act of coition, under ordinary circumstances, was cer- 
tainly not intended by nature to be followed by any lo- 
cal injury, we cannot conscientiously abstain from urg- 
ing the advice upon all who may have incurred the 
slightest injury to these organs, to seek the aid of an 
honourable and intelligent surgeon. The hints we 
shall give in this volume, will aid in distinguishing the 
empyric, and avoiding his practices. 

As chancrous discharges act with peculiar virulence 
and rapidity upon recent wounds, or even the slightest 
abrasions or cracks of the skin, about the fingers and 
nails, it is necessary to observe extreme caution. The 
writer has seen two severe cases of the disease from its 



24 CHANCRE. 

action on the fingers of physicians, who had attended 
females in parturition, when afflicted with chancres. It 
is also frequently conveyed by the fingers to the eyes of 
patients, and destroys that organ with fearful rapid- 
ity. Neither patient nor physician should ever attempt 
the least manipulation in this disease, without previous- 
ly providing a bason of water, and forceps, with which 
all dressing should be done, and never with the fingers. 



CHAPTER III. 

BUBO. 

The second frequent, though not necessary symptom 
m the order of occurrence, is Bubo, from the Greek 
Boi;ffw»/, the groin — because they usually exist in that 
part. A bubo is defined, " a painful swelling of a 
lymphatic gland, produced by absorption of the venereal 
virus ;" although, as will soon be seen, they originate 
from other causes. Now the intelligent reader will at 
once ask, what is a lymphatic gland 1 Throughout 
every part of the human body, as well as arteries, nerves, 
and veins, there is another set of vessels equally numer- 
ous, called lymphatics. Their specific object, being to 
convey the superfluous secretions made by the blood 
vessels, all over the body, back into a large internal and 
deep-seated vessel, that takes up the prepared food called 
chyle, and throws it, together with the lymph, into the 
veins ; thus again submitting the whole to the action of 
the arteries, and converting it to the general uses of the 
economy. The lymphatics, so called from their con- 
veying lymph, or a colourless fluid, in various parts of 
the body, as in the groin, arm-pits, <fcc, — are convoluted 
into small knots, called glands. They are also called, 
from their office, absorbents ; those that originate from 
the private parts, as well in the male as in the female, 
3 



20 BUBO. 

go into the upper tier of glands in the groin, or just 
above the thigh ; they .ire from five to eight in number, 
and might constitute as many bubos, if the chancres 
were sufficiently numerous to poison all the lymphatics 
whence they derht their origin; this is not, however, 
the case ; there are rarely more than two, oftener one. 
Now as each groin has its own glands, and each side of 
the penis its own lymphatics, the bubo will originate on 
the corresponding side with the chancre or chancres. 
If there were but one chancre, and especially if 
that should be situated on the lower part, and on the 
dividing line of the penis, it. might produce it on either 
or both sides. If by chance a chancre should exist on 
the upper and inner part of the thigh, it would produce 
a bubo in the lower tier of glands, on the upper part of 
the thigh : and if on the finger, the bubo would be in the 
arm or the arm-pit : about the lips or mouth, at the 
angle of the jaw, or under the tongue. Thus, it is seen, 
the superficial lymphatics will absorb poisons, as well as 
fulfil their proper purposes, and thus by external appli- 
cation to them, mercury is often made to reach the 
gland, and annihilate the poison on its way to the sys- 
tem, for it does not remain in the glans, but if the bubo 
be not cured, is reabsorbed into the system and enters 
the blood, producing all the symptoms subsequently to 
be explained : these are entitled constitutional symptoms. 
The first important point to be noticed, in treating of 
bubo, is, that according to the observation of some very 
distinguished surgeons, they may originate, (and, a9 
subsequent constitutional eruptions prove) be distinctly 



BUBO. 27 

syphilitic, without any chancre or even the slightest visi- 
ble abrasion. Mr. Hunter has seen instances, and John 
Bell of London, observes, that he " has recorded up- 
wards of twenty cases." The writer of this work has 
submitted to the notice of a distinguished surgeon ot 
this city, a case in which constitutional eruption follow 
ed a bubo, without a chancre. The patient declined a 
mercurial course, which was urged upon him from the 
knowledge of Mr. Bell's observation, and the persistence 
and suppuration of the bubo. In such cases, (fortunate- 
ly very rare) we have nothing to help our opinion of the 
propriety of mercury but the latter points, and I do not 
hesitate to advise mercury in all such cases, if there be 
no other sufficient cause for a sympathetic bubo, such as 
its occurrence after great fatigue, violent jumping or 
wrestling, mechanical injury of the generative organs, or 
the foot or thigh, all of which might do so, and if the 
patient were scrofulous, the bubo would prove very dif- 
ficult to remove by local means. 

The poison from the chancre may also cause ulcera- 
tion in the small track of lymphatics along the penis, 
before they become convoluted to form the gland, or 
bubo. I have known the virus stop and spend all its 
force in the formation of extensive ulceration at the root 
of the penis, and form no bubo at all. 

A syphilitic bubo, when open and discharging mat- 
ter, is in all respects similar to a chancre. It is a 
chancre upon a large scale, and the matter will produce 
other chancres, if care is not used ; hence the neces- 
sity of great cleanliness and circumspection. But here 



28 BUBO. 

the specific effects end. The constitutional symptoms 
will not produce their like, even if the matter be apphed 
to the abraded skin.* And now the reader understands 
the meaning of primary and secondary symptoms. All 
after the bubo are secondary ; the chancre bubo and 
lymphatic enlargements, if any, are primary. 

Bubos usually form within a fortnight or less — the 
general period not exceeding a week from the appear- 
ance of a chancre, although they may be met with at 
any period of its existence. A chancre may remain 
quiet for some considerable time, then suddenly become 
irritated and painful, when the bubo will follow quite 
unexpectedly. The application of caustic to a chancre, 
or the rubbing of mercurial ointment on the thigh, may 
produce a bubo, and one that is not syphilitic, being 
produced solely by the irritation of the lymphatics. And 
yet this bubo, of course the reader will see, has a right 
to become syphilitic, so long as the chancre be not de- 
stroyed or healed. 

In a vigorous constitution, a bubo proceeds much 
more rapidly to a termination by suppuration, than in a 
delicate one, generally ending in that disagreeable re- 
sult by a fortnight. In scrofulous persons they may 
last for months, to the great annoyance of the patient 
and surgeon. And patients should always remember 
that their cases are peculiarly stubborn, even in the 
most skilful hands. And here let me remark, that the 
fretful and querulous stand greatly in their own light : 

* The ulceration of the nipples, caused by the suckling a syphilitic 
child, seems to be an exception to this rule. 



BUBO. 29 

in all diseases the recuperative powers of the system 
are best exercised under an equable state of mind, but 
peculiarly so in this disease, for reasons known to every 
man who reflects upon the depressing influence of dis- 
ease in the generative organs. The patient, then, 
should cultivate equanimity of temper. It is the special 
object of the writer to show the difficulties and doubts 
that environ this disease, even in the most skilful hands, 
and to enable the unfortunate to shun the heartless igno- 
rance of empyricism. 

There are, in several authors of the most distinguish- 
ed character, opinions advanced that constitutional 
symptoms will not occur, where the syphilitic bubo dis- 
appears without suppurating, to which the most success- 
ful practitioners of our country entirely dissent. For 
myself I am happy in coinciding with them to say, that 
I do not know a single medical man who has the least 
doubt upon the propriety of a moderate use of mercu- 
rials, in all cases where it is not perfectly clear that the 
bubo is not syphilitic. And here it must be remem- 
bered that the chancre may occur entirely within the 
urethra, and so closely simulate gonorrhea, with which 
indeed it may be combined, as to deceive both the pa- 
tient and physician. Nay, sympathetic bubo will ap- 
pear in clap itself. I can only say that the patient 
should rely exclusively, in such cases, upon the astute- 
ness of his surgeon, and I need not urge the latter to 
give him, as they say in the law, the benefit of a doubt, 
and incline to prudence. I have nothing to say with re- 
gard to the choice of treatment. Rest, leeches, mercu- 
rial frictions on the thigh, blisters over the bubo, nitrate 
3* 



30 BUBO. 

of silver freely applied, moderate pressure, makeup the 
sum of efficient means. And I confess myself an ad- 
vocate for an early opening, as soon as matter has 
formed, believing, from my own observation and that of 
numerous friends, that its absorption is very rare, and 
that its presence can only produce injury and annoy- 
ance to the patient. 

Poultices are often applied in the early stage of bu- 
bos. This is wrong. We should endeavour by all 
possible means to prevent their opening ; but if it is ev- 
ident they will advance to suppuration, the practitioner 
who is not confident of his ability to detect matter in 
its early stage of formation (and that is sometimes diffi- 
cult, as there is a dense fascia or sheath of membranous 
structure over these glans,) should apply a poultice 
till the matter is sufficiently distinct. Warm water, ap- 
plied by a sponge, is the preferable and more cleanly 
method ; but this is often impossible, as the patient re- 
fuses confinement to the house. The practice of open- 
ing bubos with caustic is very painful, and I believe 
now nearly obsolete. The lancet is the method most 
in use. As soon as the bubo ceases discharging, a so- 
lution of nitrate of silver, five grains to the ounce, will 
be of service in promoting healthful granulations. It 
may be increased to ten, and even twenty, and if the 
edges of the sore are hard and indolent, the pure stick 
may be applied. Yet all this rests with the judgment 
of the practitioner. 



CHAPTER IV. 



SYPHILITIC SORE THROAT. 



This is very apt to be the first constitutiona symptom, 
though eruptions on the skin may precede it. There 
is no specific period for its occurrence, and its appoach 
is so like that of a cold, that it is often so called by the 
patient. It is said, and I think justly, by many authors, 
that this is more likely to occur when the poison has 
entered the system directly by the absorbents, without 
the formation of a bubo. They suppose it spends its 
force there and we know that the bubo delays its en- 
trance into the constitution, for a time at least. A 
bubo may often be checked in its forming stage by 
mercury ; and then the poison, having also entered the 
system, either from the same chancre that formed the 
bubo or another, that shall form none, and an insuf- 
ficient quantity of mercury having been given to neu- 
tralize the constitutional affection, sore throat and other 
affections may occur. It is in such cases that the pro- 
fession gains discredit, and it is well to err on the side 
of prudence, and not to assume a chancre or a bubo 
to be non-syphilitic, because it soon yields to mercury: 
very often, if an accurate examination is made, hard- 
ness will be perceived, either in the chancre or bubo, 
and this is an evidence of the propriety of continuing 
the mercurial treatment. 



32 SYPHILITIC SORE THROAT. 

Sore throat may happen as early as ten days 
after infection, and it may be months after all the 
primary symptoms have disappeared. It often ap- 
pears in the form of an ulcer, copper coloured, and 
very small, on one side of the throat very far back : it 
will occasionally remain a long while stationary, and 
then advance with unexampled rapidity over the arch 
or curtain of the palate, to reach the opposite side, 
and on its way destroy the uvula, or hanging palate, 
as it is often called, — all these parts may be destroyed 
in a few days. This ulcer is often accompanied with 
general inflammation and distressing burning sensa- 
tions, and sometimes distinct erysipelas, if it be not con- 
trolled by mercury ; it will attack the bony part of the 
roof of the mouth and ulcerate it through, thus destroy- 
ing the voice by opening the mouth into the nostrils. 

It is here also that the hearing becomes impaired, bv 
inflammation attacking an important tube, conveying 
air from the mouth to the ear ; this becomes closed, and 
thus produces deafness, air on either side of the tym- 
panum being essential to perfect hearing. A very an- 
noying secretion of mucous is often produced during this 
affection, causing a constant effort to clear the throat. 

The affection with which syphilitic sore throat may 
be confounded, and thus cause needless alarm, is the 
ordinary and violent sore throat. To this the patient 
is quite liable under the use of mercury ; and indeed, 
in our climate at all times: syphilitic sore throat is attend- 
ed with ulcers of a copper colour, and forming on the 
surface,— ordinary sore throat, either with general red- 
ness of a much lighter hue, or abscesses having matter 



SYPHILITIC SORE THROAT. 33 

within them ; the ulcers, moreover, have smaller and 
buff-coloured crusts or sloughs on their surfaces ; and 
the parts in ordinary sore throat, without being even 
visibly ulcerated, are often covered with an extensive 
milky exudation. 

There are on the tonsils, or as they are often call- 
ed, the almonds of the throat, as far back as one can 
see, many natural irregularities — these must not be mis- 
taken for ulcers. Should the patient have been for some 
time under the use of mercury, and either have taken 
it in excessive quantity, or, as is also often the case, 
been predisposed to scrofulous affections of the throat, 
other difficulties will arise, which are to be left, of 
course, entirely to the skill of the practitioner. In such 
cases, besides the ordinary rule of the preceding his- 
tory of the case, whether mercury has been taken, &c, 
as well as the general appearance of the patient, the 
physician, by a careful attention to regimen, and hav- 
ing the entire control of every circumstance likely to 
injure him, will run no risk, even if ulceration of a 
doubtful character should exist, by waiting a short time, 
and observing the progress of tne disease. 

During this interval, he will probably test the action of 
caustic, a remedy of the utmost value, and one which will 
control more unmanageable ulcerations, under even the 
most opposite condition of circumstances than any other, 
nay, we believe, than all others put together. It is here 
that the most entire trust in the surgeon is necessary, 
and unhappy indeed is both patient and surgeon if this 
be not reciprocal. The surgeon, if his heart is right, 
will not fail, should he deem it necessary, to suggest the 



34 SYPHILITIC SORE THROAT. 

aid of friendly counsel ; and when this is done to their 
mutual satisfaction, he should proceed confidently in 
the treatment agreed upon, and carry it out to the ut- 
most of his abilities. Then, even if the result be 
unhappy, that man is recreant to every principle of 
honour and manly fortitude, who visits his misfortunes 
(originating in the gratification of his own appetite) 
upon the reputation of his faithful surgeon. 



CHAPTER V. 

ULCERS IN THE NOSE AND MOUTH. 

Although ulcers of the throat, mouth, and nose, do 
not invariably attack in the order of their enumeration, 
still the throat may generally be called the place chosen 
for the first appearance of constitutional symptoms. 
Should the disease have been suffered to progress with- 
out mercurial treatment, or an insufficient quantity been 
given to check it when in the throat, and it appear again, 
it will proceed generally to the mouth and nose, as though 
no mercury had been given. 

The remarks made when speaking of the throat, 
apply equally to the mouth, with this exception ; that 
when it attacks the roof of the mouth, it will often pro- 
ceed to the destruction of the bone with great rapidity, 
a few days after the copper coloured spot first appears, 
generally in the middle of the roof, the bone may be- 
come ulcerated, and a permament opening made into 
the nostrils, thus impairing the voice, and causing nasal 
itterance. This fortunately admits of the adaptation 
if a gold palate; several cases have been thus treated 
n masterly manner in this city. The first appearance 
of ulceration in the nostrils, is apparent by a stoppage 
accompanied with pain at a particular part. With the 
aid of a speculum, (an instrument for dilating the nos- 



30 ULCERS IN THE NOSE AND THROAT. 

tril) it may be seen high up on what is called the spongy 
bone on one side. A very foetid and almost insup- 
portable discharge precedes the coming away of the bone 
itself, and a constantly weeping eye is caused by the 
stoppage of the tear duct, that conveys the tears down 
the side of the nose to the nostril. Should the great 
septum or dividing bone of the two nostrils be attacked, 
the nose falls and becomes flat with the face. The 
wing or cartilage of the nose may be attacked, and has 
been occasionally presented to the surgeon as a cancer, 
and in one instance had actually been removed by a 
quack, by means of what is called a cancer plaster, — a 
most cruel and accursed experiment of those wretches 
in human shape called cancer doctors ; a class of 
humanity, who seem to have been formed after sympa- 
thy was exhausted. And here I would remark, let 
every afflicted person beware of these and other pre- 
tenders : — even after long, long years, he thinks bis se- 
cret safe, and that the virus is exhausted, these local af- 
fections may arise : in the chapter on anomalous symp- 
toms, he will find an account of these reliquiae, which 
occasionally pass for cancers, tumours, &c. 

There is an occasional result of mercury, viz. : a 
temporary swelling of the cheek, that may produce 
alarm in the patient, by pressing upon a broken tooth, 
and causing the semblance of an ulcer : this is readily 
understood by the physician. The tongue is liable to 
thickening and ulceration, that produces a very alarm- 
ing appearance, and often simulates cancer: it is too 
rapid in its progress, however, and the history of the 
case will also be sufficient to determine its nature. 



ULCERS IN THE NOSE AND THROAT. 



37 



There is one caution to be most carefully remembered 
by the patient : after mercury has been given, and it has, 
as it occasionally will, though this is always deprecated 
by the surgeon, produced soreness or ulceration of the 
mouth, and it should be discontinued for a time, and 
perhaps for good, the patient must not, as I have often 
known them do, continue taking it by stealth, for he 
may actually produce sloughing or mortification of the 
cheek, and even death itself; in fine, he should either 
trust his surgeon entirely, or discharge him. 



CHAPTER VI. 

ERUPTIONS OF THE SKIN, AND ULCERS. 

With the exception of what remains to be said on 
some of the more serious affections of the bones, we 
have now reviewed those symptoms that excite the most 
alarm in the patient, and respecting which the instruc- 
tion we have endeavoured to give is of the most import- 
ance. We take it for granted that having read thus 
far, he either is or has resolved immediately to place 
himself under proper care. 

There is indeed so great a variety of constitutional 
eruptions, that it would not comport with our purpose 
to give their individual appearance as this would also 
require the aid of the colourist. The skin, as we 
have said, is occasionally affected before the throat or 
mouth ; but this is not common. The breast and arms 
are most frequently the first in order of attack. There 
is very little uneasiness and no pain attending these 
eruptions : a very slight itching occasionally is felt. 
Those most frequent are at first of a copper colour, yet 
ofamnch paler tint than they subsequently assume; 
they look often like blotches, and project very little from 
the skin; on minute examination, they may be found 
composed of pustules so slightly charged with fluid, that 
it dries away, and the whole surface may be rubbed off 



ERUPTIONS AND ULCERS. 39 

like bran. They often disappear, and the skin is left 
sound beneath them, yet, as the reader has already ob- 
served, there is no tendency in parts afflicted with syph- 
ilis to heal ; tenderness or irritability is left, and either 
immediately or soon after the first blotch has disap- 
peared, another takes its place, a thicker crust, pro- 
duced by the little pustules forms, and on this being 
rubbed off, a* small ulcer appears. 

They have been confounded in their incipient state with 
tetter or ring worm, and have, indeed, somewhat the ap- 
Dearancein colour and shape, and the fact that they both 
persist, unless remedies are used. There is, however, 
no doubt of their nature when ulceration occurs, as the 
matter of syphilitic ulcers differs very much from tetter, 
£ew of the latter yielding discharge. The matter of a 
venereal ulcer, as we have seen, in the mouth, is viscid 
and flaky, and appears like melted lard ; that of tetter, 
with one exception, (otherwise sufficiently character- 
ized,) is thin. The history of the case, moreover, will 
give every reason to suppose what is the nature of the 
eruption. 

There is a pustular affection of the skin, that appears 
in distinct vesicles, like small-pox. These soon dry and 
leave a scab. And again, a scaly eruption, particularly 
about the face, in which one scale will be piled upon 
another, even an inch in height. This is a very stub- 
born and unmanageable form. Of course all these erup- 
tions require constitutional reu edies, and frequently 
baths, with a very strict attention to regimen. The pa- 
tient, if at all intelligent, will rely exclusively upon his 
Attendant. The thighs and lower parts of the body are 



40 ERUPTIONS AND ULCERS. 

last affected, — the hands and face being commonly at- 
tacked after the arms and shoulders. 

Ulcers. — Besides the ulcers that form in the throat, 
mouth, and nose, and those that succeed bubos, ulcera- 
tion may exist in any other part of the body. Yet it is re- 
markable that secondary ulcers are the last to attack the 
genital organs, though the primary, viz. the chancre, 
commonly begins there. 

Ulcers about the body usually begin, as we have said 
in the last chapter, in the form of blotches or pustules. 
There is a remarkable difference between them and or- 
dinary ulcers that succeed to abscesses, such as boils, 
&c. They rarely continue on the surface, not only bur- 
rowing, but from the very beginning, having a tenden- 
cy to destroy the parts beneath, as well as the skin it- 
self. As soon as the skin is destroyed, all the parts be 
tween it and the bone are often in the same condition 
Indeed, this rapid destruction of parts, is only common to 
this disease and mortification : in no others does it hap- 
pen. 

It has already been repeatedly noticed, that syphilitic 
sores, unlike others, produce no pure matter, nor gran- 
ulations, at least till they begin to heal. They secrete 
an ill-looking, thin, and bloody, and occasionally a 
tough and greenish discharge. The skin surrounding 
them has a diffused red colour, and they are almost al- 
ways without pain. At a later period, even in healthy 
persons, they seek the deeper seated parts, and always 
much sooner in those who are naturally feeble. They 
are always influenced much by the constitution, and de- 
mand varied treatment; — mercurial often, nay always, 



ERUPTIONS AND ULCERS. 41 

at some period of their continuance, and frequently to- 
nic treatment combined. 

Erysipelas often attacks the skin around the ulcers, 
and demands its appropriate treatment, whilst the ulcer 
assumes such a variety of aspects, that it requires all 
the tact of a sound and judicious practitioner, to dis- 
criminate the varied phases of constitutional affection, 
indicated by this ever-changing affection. When they 
attack the bones, I am satisfied that the system best re- 
sists their inroads upon the performance of its functions, 
by a judicious combination of mercurials and tonics ; — 
amongst the latter that invaluable gift of chemistry, the 
hydriodate of potass, which is always used by the mod- 
ern practitioner. There is no tonic like it, and it is no 
doubt true, that one half the cases that formerly died 
under protracted syphilitic affections, and the abuse of 
mercury, are cured by it alone. It is an anchor of hope 
to the surgeon and patient ; and this is the testimony 
of almost every practical surgeon. 

Nutritious diet, and even porter and wine, is here re- 
sorted to, but all must rest with the medical atttendant. 
The patient must not expect much benefit from any lo- 
cal applications in any form, for he will be disappoint- 
ed utterly in any amendment, till the poison is checked 
in the constitution. King David well exclaimed, 
" There is no soundness in my bones because of my 
sin." 

Nothing can be more annoying to a surgeon than the 
continued desire of the patient for some new applica- 
tion. I have often been wearied by these requests, and 
oftener felt that an apparent compliance with the pa- 
4* 



42 ERUPTIONS AND ULCERS. 

tient's wishes, as to their renewal or continuance, low 
ered me in my own and his estimation. Indeed, it is 
far best to assure the patient in the beginning, that you 
mean to assent to every proposition, however ridiculous 
that will not injure him. Let him prescribe for the sore, 
and the surgeon for the disease. 

A very humorous and scientific friend is wont to tell 
his patient that he may put every thing on the sore, 
from " pigeon's milk upward." He may " grease it 
with every thing but aqua-fortis and lightning " — so 
long as he obeys the medical prescription. 



CHAPTER VII. 

NODES AND SWELLINGS OF THE TENDONS. 

Wherever the bones are thinly covered with flesh, 
as in the shin, or outside of the arm, the forehead, or 
the shoulder-bone, as it is improperly and often called, 
swellings, rarely larger than half a walnut, either soft 
or very hard, will often appear towards the latter part 
of the disease. These are most likely to occur either in 
bad constitutions, that have often been affected, or in 
those where the disease has been suffered to progress 
without treatment, but more especially in those who 
have been much exposed to dampness. They either 
exist in the substance or body of the bone, or directly 
beneath the delicate membrane that covers it. When 
the tumor attains the size of a cranberry, the skin be- 
comes red and tender ; gradually it ulcerates in those 
that do not remain stationary, and upon discharging 
its contents, the bone itself is found carious : in the 
state of progression it is exquisitely painful, — this ceases 
as soon as it is opened. The administration of mer- 
cury usually stops the progress of these tumors, and 
causes them partially to recede. Should the constitu- 
tion regain its full powers, frictions with appropriate 
ointments will cause a very slight diminution, but they 
generallv remain enlarged for life. 



44 NODES AND SWELLINGS. 

It is not to be denied that these thickenings of the 
bone, as they are familiarly called, or nodes, are most fre- 
quent in those who have undergone repeated and injudi- 
cious courses of mercury ; and it has even been said that 
they never exist in those who have not taken it. And 
what of this? Does it follow that the patient should 
not take it? If he prefers the constitutional eruptions 
and sore throat, with the destruction of his palate, he 
can be accommodated. In a late very distressing case 
that came under the notice of the author, it was urged 
amongst other reasons, by a quack of the homoeopathic 
order, that " mercury rotted the bones, and produced 
tumors upon them," (these sentiments being shown in 
Cooper's Surgical Dictionary, a truly distinguished 
authority,) to the patient. Homoeopathy was his only 
salvation, and he had it, at the expense of a constitu- 
tional eruption, and the entire loss of his palate, both 
processes going on at my first visit. 

It is a principal object of this volume to assist the 
patient in forming a correct conclusion, and to put him 
so far right in his train of thought, that lie may not be 
victimised by quackery. I shall not attempt to conceal, 
when speaking of mercury, its actual dangers. One 
half the trouble from the use of this utterly indispensa- 
ble medicine, originates in the injudicious concealment 
of its administration, or an inadequate representation 
of the necessary cautions to be used whilst taking it. 
Rheumatism often attacks many of those under a mer- 
curial course, and it is a most unmanageable and dis- 
tressing affection. 

Besides permanent or hard nodes, there are soft ones, 



NODES AND SWELLINGS. 45 

These may strictly be called, separated from unneces- 
sary complexity of definition, collections of matter un- 
der the investing membrane of the bones. The same 
observation respecting their permanency, does not ap- 
ply to them. If they do contain matter, as soon as it 
can be distinctly felt, which, by the way, is difficult, it 
should be released by a puncture with the lancet, 

Besides these two varieties of nodes, there will occa- 
sionally originate more extensive swellings, sometimes 
called rheumatic by the patient, in various places over 
the bones. They are, however, of a much harder na- 
ture than swelling consequent to, or accompanying 
rheumatism ; the latter being erratic in its location, and 
therefore disconnected with the bone ; the former are not 
so. These latter, however, unlike bony nodes, admit 
of complete dispersion in time. 

The sheaths through which the sinews or tendons 
play, occasionally enlarge, and thickenings of the ten- 
dons themselves, with consequent impediment in their 
functions, occur. Mercury, either by the mouth or fric- 
tion to the limb, is the remedy for these symptoms — 
nothing else has the least, effect upon them. They are 
by far the most likely to exist with debilitated or scrof- 
ulous persons ; and a correct estimate of the actual ex- 
isting powers of the system, and its capacity to tolerate 
this medicine, with a judicious combination of tonics, 
can only be ma^e by the careful and observant sur 
geon. 



CHAPTER VIII. 

EXCRESCENCES NEAR THE ANUS, AND SWELLINGS OF 
THE TESTICLES. 

Around theverge of the anus, there will at times occur, 
particularly in such as have often had syphilis, enlarge- 
ments of the skin in isolated portions : sometimes they 
project half an inch from the surface ; they are round 
or irregular in form, observing no rule either in the tim« 
of their appearance, or shape. The most rapid and 
least painful method of removing them, is to clip them 
off with scissors. 

Although swelling of the testicle is almost peculiar to 
gonorrhea, as will be seen when treating on that com- 
plaint, still it occasionally occurs in syphilis, where there 
are no existing symptoms of gonorrhea ; for, the reader 
will observe, the diseases may occur together. Swell- 
ing of the testes, in syphilis, is not common, however, 
and it is only noticed because it does, though rarely, 
occur, and is from its unexpectedness peculiarly alarm- 
ing to the patient. The enlargement, as it is appropri- 
ately called, to distinguish it from permanent hardening 
or cancer of this organ, a disease to which it is also sub- 
ject, appears without pain of an acute kind, and only 
excites the attention of the patient from its increase of 
bulk and weight. In the swelling of this gland, that 



SWELLED TESTICLE. 47 

originates in gonorrhea, the pain is considerable from its 
commencement, and it extends to the back and loins ; 
it is also much aggravated on assuming the vertical pos- 
ture, and the patient is glad to seek relief by lying down. 
The former progresses very gradually, often requiring 
weeks to attain the size that the latter acquires in iwo 
days: this is often, in both, the size of a hen's egg. 

To distinguish it from the cancerous affection above 
mentioned, it may be remembered that the latter is still 
more slow in its accession, is accompanied with much 
sharp stinging pain, becomes very knotty and irregular 
over its entire surface, and soon extends up the cord to 
the groin. The syphilitic testicle may also be accom- 
panied with effusion of water, constituting dropsy of this 
part ; this is described in another chapter. (See Hydro- 
cele.) As mercury is the only means of cure for this 
affection, and it removes it with certainty and rapidity, 
it will soon relieve the anxiety of patients. 

The only additional' remark I feel it necessary to 
make, is to urge the patient to submit to the recumbent 
posture entirely. Nothing is more absurd than to ex- 
pect the benefit of a surgeon's efforts in alleviating this 
complaint, than by continuing on the legs, even if con- 
fined to the chamber, or sitting, it is all wrong alike. 
No benefit can follow, so long as the blood is prevented 
from returning to the great vessels of the body, by com- 
pelling it to ascend through a long and tortuous system 
of vessels, before any of it can be driven from the dis- 
eased organ. This is, without any exception, the most 
necessary observance in treating any diseases of the' 
genital organs. The whole of this matter is fully ex 



48 SWELLED TESTICLE. 

plained in the chapter on gonorrheal swelled testicle, 
and it will then be seen, that amendment whilst stand- 
ing or walking about, is considerably more absurd than 
expecting water to run up-hill. 



CHAPTER IX. 

ALOPECIA ; OR, LOSS OF HAIR. 

From what I have heard in conversing on this sub- 
ject, I believe it to be productive of greater anxiety, I 
had almost said, than the actual loss of virility itself 
There are so many causes of a general or constitution- 
al nature for this symptom, and that too in such as have 
never known any form of syphilis, or ever taken a grain 
of mercury, that I intend to set forth its nature in the 
most frequent cases, with sufficient minuteness to pre- 
serve, if possible, the illusion of its reproduction by the 
thousand and one nostrums of the day. 

Any person of common powers of observation and 
reflection, cannot fail to have observed, that the hair is 
the first point on which the hand of time makes its im- 
press, even in those, who long after the appearance 
of actual baldness, give the greatest proof of physical 
power, and plainly show, that they are in the very me- 
ridian of strength. Nay, if the proof that is supposed 
to be beyond all other assurance be wanting, nothing is 
more common than the birth of numerous children to 
those who have doffed their raven locks, and whose gray 
hair and bald crowns, with an erect and youthful bear- 
ing, bring to mind an inauspicious spring in our ever- 
varying climate. 
5 



50 alopecia ; 

The remaikable difference in the growth of hair after 
cutting, and its reproduction after ordinary sickness in 
extreme youth, shows conclusively great difference in 
the constitutional power of the circulation. Look, for 
instance, at the brown hue and firm muscle of an ur- 
chin we now and then pass, and the doughy appear 
ance of his companion. The one with drooping, red- 
skirted and lack-lustre orbs, — the other sparkling with 
health, and reflecting the brilliancy of his eyes upon his 
wan companion. Shut your own eyes, and pass your 
hand over the faces of these children. Is it fancy, or is 
there a great difference in their warmth, and if I may 
so sny, pungency in their skin 1 The eye-lids and the 
skin of the head, are both in the same condition. The 
contractibility of the individual blood-vessels, in the one, 
is impaired, and they cannot force along the blood, or 
yield to the action of the heart, so as to feed the glands 
which produce the hair. The blood is not renewed oft- 
en enough, and diseases of the skin show themselves 
in consequence. These are called congestive in char- 
acter. 

Each individual hair is supplied with its separate 
gland, which elaborates it, and continues its growth 
from the blood. It is in all respects similar to any other 
gland, so far as its powers of production are concerned. 
Now the testicle is a gland, and if we have been at all 
successful, when speaking of the swelled testicle, the 
reader will understand that the gland is affected with 
want of action, or congestion. All this as we see ap- 
plies, so far, to a state in which there is no syphilitic 
poison. 



OR, LOSS OF HAIR. 51 

If the falling of the hair then, be one of the first 
symptoms of bodily failure, though, as I have said, so 
insidious as to be inappreciably connected therewith in 
its commencement, how much plainer to the understand- 
ing does it become, that the depressing influence of se- 
vere constitutional disease, nay, the actual existence of 
a specific poison, in the very glands that produce it, shall 
effect this result. And if a gland, as large as the testicle, 
sometimes, and not unfrequently either, should wither, 
and even disappear entirely, as is well known to surgeons, 
how far more likely is one much less than the size of a 
mustard seed, to be obliterated from the same causes ? 
Explain this to your own understanding, and then pes- 
ter yourself with nostrums if you like. 

The first symptom of the loss of hair, is of course its 
coming out in combing. And if the patient exam- 
ine the comb, he will find a number of branny scales. 
This is the scarf skin, thrown off in consequence of the 
feverish, congested state of the true skin below, in 
which the bulbs of the hair originate. This state of 
things will go on till the person becomes bald, and some- 
times in severe cases the eye-brows will come out. The 
beard and whiskers are the last to suffer, and generally 
resist the disease entirely, or become prematurely grey. 

There is but one remedy I have ever known to pro- 
duce any effect, and this is mercurial in character, and 
thus its action is explained upon the presumption of its 
direct anti-syphilitic action. It is the yellow wash, often 
used by surgeons as an application to syphilitic and 
other ulcers. Should this fail, I would urge the patient 



55J ALOPECIA. 

to make one or more sea voyages, as there is nothing 
that will elevate the constitutional powers so rapidly, as 
this measure. Venery should be entirely avoided, and 
every other excess shunned. 

All applications, except shaving and friction, with the 
yellow wash, are prejudicial. They load the skin, and 
prevent the performance of its functions. The benefit 
that sometimes follows their use is due exclusively to the 
friction. 



CHAPTER X. 

BLINDNESS AND DEAFNESS FROM SYPHILIS. 

When blindness originates from any alteration of the 
surface of the eye-ball, and comes on gradually, it is 
sufficient for all purposes to say to the general reader, 
that it occurs from causes precisely similar to those 
just explained, in treating of the loss of the hair, 
congestion of the blood-vessels in the internal tissues of 
the eye. The reader will remember the caution given 
him when treating of chancre, and observe that in case 
of the direct application of the matter of a primary sore, 
specific effects, and a rapid obstruction of the eye would 
follow. The blindness now under consideration is a 
constitutional symptom. Should there be no visible 
alteration of the tissues or contents of the eye-ball, and 
sight should fail, then the affection is the result of dis- 
ease of the optic nerve, and is for the most part quite 
incurable, as it never happens till the system is so com- 
pletely broken down by disease, that permanent disor- 
ganization of the retina has occurred. So far as my 
experience goes, no treatment will effect any benefit. 

The same remarks apply to diseases of the ear. If 

there should be discovered any alteration, either in the 

mouth, affecting the tube spoken of when treating of 

ulceration there, or should polypi, or other tumors 01 

5* 



54 BLINDNESS AND DEAFNESS. 

swellings have formed in the external ear, then the loss 
of hearing may be imputed to such alteration or tumor. 
If, on the contrary, no structural derangement exist, 
the symptom is owing to paralysis of the nerve of hear- 
ing, an affection analogous to that of the eye, and as 
far as my experience goes, equally incurable. 

There is, however, occasionally occurring during the 
progress of constitutional syphilis, a very sudden affec- 
tion of both the eye and ear, quite transient in char- 
acter. It often disappears spontaneously, and is great- 
ly benefited by blisters. It is those affections only that 
are insidious in their approach that produce the most 
lasting derangement of these organs. 

The eye-lids also are affected with a very tedious in- 
flammation of a similar nature with that of the skin, 
having this difference peculiar to their structure, which 
around their edges are glandular. The reader will re- 
member, that it is the office of a gland to secrete or pro- 
duce from the blood something of a different nature from 
it. Now the lids secrete a mucus, of a bland and un- 
irritating character, to defend them from the acrimony 
of the tears, as they form a gutter, to convey the latter 
to the nostrils, through the minute holes at their junc- 
tion near the nose. This mucus becomes thick and 
gummy in its nature, and the eye-lids, unless anointed 
with some soothing unguent, are constantly sticking to- 
gether, to the great annoyance of the patient. The af- 
fection, however, in common with all others resulting 
from constitutional syphilis, can only be removed by sci- 
entific effort. " All within and without is corrupt." 



CHAPTER XI. 

IRREGULAR AND OCCASIONAL SYMPTOMS. 

There are a variety of annoyances still to be enu- 
merated, occasionally consequent on syphilis, amongst 
which the most frequent is rheumatism. This is often 
most aggravating at night, and wreaks its peculiar ven- 
geance upon the shins and head, though other parts of 
the body are occasionally affected. It has been a ques- 
tion with the medical profession, how far this was due 
to the administration of mercury, an^ how far to the 
disease. If the observations made by so many of our 
army and navy surgeons be true, that nodes and affec- 
tions of the investing membranes of the bones, are most 
frequently to be found in those who have taken mercury, 
and not in others, it would seem to be due to the mer- 
cury ; for syphilitic rheumatism is undoubtedly often 
seated in these membranes : yet, as we said before, what 
then'? will the patient run the risk of constitutional af- 
fections and destruction of his palate 1 for this is the 
only alternative : — fortunately, we are able to effect the 
greatest benefit, and often cure syphilitic rheumatism, 
with that invaluable medicine, the hydriodate of potass. 
How far the reasoning is correct of those who impute to 
mercury what may be due to the feeble powers of the 
system, remains to be proved. I have often seen 



56 IRRRGULAR SYMPTOMS. 

rheumatism in every respect similar to syphilis, where 
no mercury had been taken. A variety of local enlarge- 
ments occur in syphilis : — the scrotum is sometimes 
thus affected, and may be confounded with disease of 
the testicle : the opinion of an intelligent surgeon will 
best relieve the anxiety of the patient. No directions 
would avail him to form a correct one of his own. 

An affection may be engrafted upon this thickening 
of the skin, that will test the patience of both the at- 
tendant and patient : I allude to an ulcer attacking this 
part. Now it is generally known, that even if the spe- 
cific poison should be utterly removed from the system, 
still these local enlargements are so weakly organized, 
that if any sore attack them there is little tendency to 
heal ; they resist treatment, and persist for so long a 
time, that the patient is seriously annoyed with ideas of 
cancer, and other grievous affections. After a trial of 
the most approved modern prescriptions, such as nitrate 
of silver, and rest; iodine; Dupuytren's powder, &c, 
the writer does not hesitate to recommend excision of 
the skin, as the best means of simplifying the case ; but 
it must not be forgotten to communicate candidly to the 
patient that there may be difficulty in healing the wound 
itself, owing to the same cause that maintained the 
ulcer, viz : the weakness of the part ; still T have sever- 
al times done it with success. Sleeplessness, and wast- 
ing °f tnc body, with night stceats, are also occasional 
consequences of syphilis, and this will often induce the 
patient to enquire why he does not recover, " now he 
is cured of the specific disease." Alas, even in the 
height of vigour, the sun cannot set, but we are one day 



IRREGULAR SYMPTOMS. 57 

nearer the grave ; what shall we then say of him, who 
has imbibed throughout his whole system a poison the 
most virulent 1 

And will nature then resume her control, without her 
offended majesty complaining of the insult she has re- 
ceived, in her sanctuary 1 No ; " the trail of the ser- 
pent is left over all," and the offender can only expiate 
his sin by doing penance, in all sincerity, at her sacred 
shrine. A long and tedious probation is before him, 
and the best advice we can offer, is, to select for his 
adviser a humane and conscientious surgeon, and follow 
his advice to the letter. 






CHAPTER XII. 

IRE THERE ANY PROOFS THAT THE DISEASE IS ERAD- 
ICATED FROM THE SYSTEM. 

And now, having enumerated the consequences of 
contracting the poison of syphilis, we will conclude the 
symptoms by a reference to a question always put to the 
surgeon in protracted and obstinate cases. And it must 
be confessed that it would be very gratifying to our feel- 
ings, if we could answer with more certainty, as we 
could then guard against occasional results, most dis- 
tressing to the patient, and mortifying to the surgeon. 
We allude to its occasional re-appearance even years 
after a cure was supposed to have been effected, and 
when the patient either has or is about to contract mar- 
riage. How long then may the poison remain latent in 
the system, and what are the best presumptive signs of 
its presence ? The answer to this question may be dis- 
tinctly given. 

Syphilitic disease may and often does appear years 
after it was supposed to be eradicated, yet we are quite 
certain that the acute observer will frequently find 
marked symptoms of its existence in the system. To 
make this intelligible, we must recur to the manner in 
which we believe the poison to have first originated, for 
by it we think we can perfectly explain its appearance 



TROOFS OF IMMUNITY. 59 

*t the most remote periods of its existence in the sys- 
tem. We believe it to be produced by a poisonous change 
of some matter secreted by the genital organs of either 
sex, produced by chemical (atmospheric) or constitution- 
al causes, aided by uniting with secretions from the gen- 
ital organs of the other, whether male or female, of a 
nature suitable for that purpose, though unknown to us. 

There is nothing whatever absurd or unreasonable in 
this. On the contrary, it is analogous to an immense 
number of chemical phenomena. Separate substances, 
whose elementary nature differs only in the proportions 
of their constituents, not only neutralize each other 
completely, the compound being totally inert when the 
separate articles would powerfully affect the economy 
of the system ; and, on the contrary, the union of other 
substances produce the most poisonous and deadly 
compounds, when they were separately known to be in- 
nocent. And now let us see the bearing of this analo- 
gy on the developement of syphilis. 

Firstly, there is, as we have seen, no positively certain 
time for the appearance of the chancre itself. Even 
six weeks will elapse before it appears. What is the 
reason for this ] It is unquestionably one of two things ; 
either the poison was not sufficiently virulent or concen- 
trated, or the action or living force of resistance of the 
part to which it was applied, was sufficient to repel it, 
the poison merely waiting beneath the cuticle, till the 
system was in a proper state to absorb it, or to present 
to it some changed condition of the blood, calculated, 
by union with it % to devclope the chancre. 

If this is fair reasoning, with regard to a primary 



60 PROOFS OF IMMUNITY. 

symptom, why not to a secondary? And how much 
more forcible does even this appear, when we reflect 
upon those cases (rare, though certain) in which no 
chancre exists, the first evidence of infection appearing 
— without even a bubo — by an eruption over the body, 
or a sore throat. And again, add to this those cases in 
which bad chancres have disappeared at a very iate pe- 
riod of their existence, either without any treatment at 
all, or at best very little, and mild in character, and not 
being followed by an eruption. 

The first evidently finds the circumstances congenial 
to its developement in the blood, though it had not suf- 
ficient power of itself to produce a primary sore. 
The second, with power enough to produce a chancre, 
and even a bubo, is not followed by a constitutional 
eruption, — proving satisfactorily that it was repelled by 
constitutional causes. 

Does not all this look as though the system would 
olerate a certain amount of the syphilitic leaven, till 
constitutional changes favoured the production of some 
chemical principle, essential to its developement? We 
think so. And here is the reason why we cannot give 
the patient positive assurance of immunity from subse- 
quent attack. We know not this principle, nor the 
causes of its production ; neither can we detect its pres- 
ence. Fortunately however, the acute observer can dis- 
cover its product, viz. certain symptoms, presently to be 
detailed, indicating its presence. And all our experi- 
ence goes to prove, that when the patient is subjected to 
a sufficient mercurial course, under appropriate regi 
men, he enjoys an almost certain immunity. 



PROOFS OF IMMUNITY. 61 

It is, however, because of the immense prevalence of 
quackery, and the irregular use of remedies even in 
skilful hands, owing to the obstinacy and ignorance of 
patients, as well as medical incompetence, that we are 
often in doubt of immunity from re-attack : and we 
shall feel as though essential service had been rendered 
the profession, if this candid enumeration of the symp- 
toms and doubts attending syphilis, should arouse the 
attention of a tythe of the afflicted, to the insanity of 
tampering with these hydra headed monsters ; we mean 
either the disease of syphilis, or quackery. 

When a surgeon is so unfortunate, as to receive a 
patient who has run the gauntlet of quackery, he is by 
no means likely to find him willing to submit to rational 
treatment: medicine, and probably mercury, is de- 
manded with importunity : this the surgeon cannot al- 
ways immediately grant, for he is not only entirely 
ignorant of the quantity and effect of what was previ- 
ously given, but he cannot possibly separate the mental 
annoyance, which is astonishingly great in these cases, 
from the effects of the medicine given by the quack. 

Should the patient be determined on immediate med- 
ication, we know of no method to control him but by 
placebos the most important, and we speak it with all 
possible sincerity, should be given by the patient to the 
surgeon, its operation being not immediately medicinal, 
but moral and reflex in character; it operates mentally 
upon both patient and surgeon, teaching the former to 
value and obey, and the latter that his prescriptions and 
advice are desirable, becautse they are payed for. 

After this preliminary, with a proper amount of 
6 



62 PROOFS OF IMMUNITY. 

knowledge and self-confidence, the surgeon may receive 
enough respect, to observe carefully, without medication 
for a week or so, his patient's case, and then he will be 
able to detect, should latent disease exist, some symp- 
toms of its presence ; either an acceleration of pulse, 
sleeplessness, flying and rheumatic pains, and swellings, 
or some other symptom upon which he can found a ra- 
tional prescription. In short, if the patient applies to a 
regular surgeon, after beginning to entertain doubts of 
quackery, it is generally the surgeon's own want of 
knowledge either of his profession or of human nature, 
if he does not obtain a chance to benefit him : we would 
merely suggest, that to a patient thus situated, the sur- 
geon will probably administer in some form, that inval- 
uable medicine the hydriodate of potass, the chances of 
benefit being almost certain, even should more mercury 
subsequently be necessary. 

Those formidable and awful affections, wherein the 
bones, especially those of the skull are attacked by the 
disease, and exfoliate, laying bare the brain itself, are 
now almost exclusively managed by this admirable 
medicine, and cases now recover under its influence, 
that were but a few years since inevitably fatal. One 
other question is often asked of the surgeon, of great in- 
terest to the patient, and although we are in the habit of 
answering it emphatically in the negative, other points 
of great interest, completely contradicting the supposed 
notion that secondary symptoms are incommunicable, 
are connected with it. 



CHAPTER XIII. 

COMMUNICABLE TO THE CHILD BEFORE BIRTH. 

Can syphilis be communicated to a female, when 
there is no sore on the genital organs, or hidden within 
the urethra 1 we say it cannot. Yet it can, and often 
is, communicated by means of the semen, to the child 
begotten by a syphilitic person, without affecting the 
mother in the slightest degree ; does not this, again, 
prove that the poison can only be developed when it 
finds a congenial and co-operative agent, and that, too, 
of a fluid character, to assist its progress. The reader 
will observe, it is only known to exist in the father by 
his past history ; for he has no eruption, or perhaps no 
other appreciable symptoms, existing at the time the 
child is begotten ; he does not communicate it to the 
mother, and the child itself is born with a constitutional 
eruption, and unless mercury is given, will die of syph- 
ilis. Why do not these symptoms exist in the father in 
all cases 1 because the co-operating agent is not there, 
in a degree sufficient to cause its developement : the 
same agent that may subsequently exist, and cover the 
father with a constitutional eruption. 

How do these ulcers in the child's mouth communi- 
cate the disease to the mother's nipple, themselves being 



64 COMMUNICABLE TO THE CIIFLD 

secondary or constitutional symptoms, nay, deriving 
their existence from the comparatively remote source 
of the semen of the father 1 The reader will remem- 
ber, that in the first chapter we promulgated the idea so 
reconcileable to prima-facie evidence, that the mucous 
membranes were the natural locality for the original 
production of the syphilitic poison, and we now throw 
out another, viz., although the discharges from constitu- 
tional eruptions of the skin, and syphilitic ulcers, will not 
produce a chancre or other syphilitic affection, if inoc- 
ulated, that they would do so in the mouth, (though it is 
said, and we do not believe, though we cannot contra- 
dict it,) that they will not inoculate the mucous mem- 
brane of the genital organs. 

Certain it is, that the poison flowing through the 
blood of the child, however attenuated and removed 
from its original source, the father, must find something 
very congenial and co-operative in the mucous mem- 
brane of the child's mouth, before it could so far add to 
its own virulence as to communicate the disease by 
sucking to its mother's nipple ; thus proving it to be 
equal in power, so far as its powers of propagation ex- 
tend, to the original poison of a chancre. Does not 
this fact, also, strongly corroborate our theory of the 
original production of the syphilitic poison. 

We advanced the idea that it was the union of some 
other irritating discharge, that might not by itself alone 
produce syphilis, yet when joined with the altered secre- 
tions of the female, be adequate to that end. Now the 
other constitutional symptoms of the infant or adult, it 
would seem, from the united testimony of all authors, 



BEFORE BTRTH. 65 

will not inoculate an uninfected person. Yet the ulcer- 
ation of the child's mouth not only produces ulceration 
of the nipples, but the whole train of symptoms belong- 
ing- to the disease. The mouth then of the infant (a 
mucous membrane) must furnish the necessary adjunct 
to produce the infecting poison. And the nipple being 
also covered with a mucous membrane and erectile 
tissue very similar in structure with the glans or end 
of the penis, as well as certain parts of the female or- 
gans, again furnishes the necessary conjunction of parts 
suitable by their structure for its propagation. 

That the child may be infected in the womb, is now 
universally admitted. We have several times examined 
the bodies of children born prematurely, and covered 
with the eruption ; indeed it is usually the cause of mis- 
carriage with prostitutes, when it comes on without arti- 
ficial aid. There is no doubt, and again the author's 
own experience is corroborated by the learned medical 
testimony of the profession, that very many instances 
of repeated miscarriage are consequent upon irregulari- 
ties of life in the husband. Several times we have been 
called upon to investigate these cases, and have found 
sufficient reason, upon a severe cross-questioning of the 
patient, to suspect a syphilitic taint. 

The careful administration of mercurial remedies has 
proved, by the subsequent birth of healthy offspring, 
that our suspicions were well founded. The reader will 
observe that in these cases, it is not necessary that the 
mother should be affected in the slightest degree. The 
poison is undoubtedly transmitted by the semen ; yet 
when there is reason to believe the child of which the 
6* 



00 COMMUNICABLE TO THE CHILD 

mother is pregnant is infected, and of this we are to judge 
by the history of the father's symptoms, and by previous 
miscarriages, if any have occurred, a cure of the child 
in utero may be effected by administering mercury to 
the mother. Among the variety of interesting cases of 
this kind, for which we have been called upon to pre 
scribe, one was peculiarly gratifying, and caused us to 
regret most keenly the errors of more youthful practice. 
A gentleman, a school-mate of our own, professedly, 
and we believe sincerely pious, married in his fortieth 
year a lady of great wealth and intelligence, nearly his 
own age. No less than seven miscarriages occurred in 
rapid succession between the third and fourth month, 
though the lady, from moral and physical training, was 
the last person in whom such misfortunes would be 
looked for. She belonged to one of our Knickerbocker 
families, and was perfectly healthy in mind and body, 
and sincerely desirous to have children. Our friend, who 
hod always employed an estimable member of his own 
church, had sufficient intelligence and candour to say, 
upon a professional visit, that, suspecting the cause of 
his misfortunes, he had called upon us, because he fear- 
ed to confess his youthful errors to a brother-christian, 
and knowing we made no professions, and our long 
friendship, had concluded to make a clean breast of it. 
He had twice been affected in his early youth, and al- 
though he believed himself thoroughly cured, had im- 
bibed some doubt from a medical book accidentally 
falling into his hands. On questioning him, I found 
him the subject of frequent slight febrile attacks, and 
sleepless nights, together with occasional efflorescence 



BEFORE BIRTH. 67 

or redness of the throat, with much difficulty of breath- 
ing, and rheumatic affection. In short, I found suffi- 
cient reason to treat him for latent syphilis, and had 
the gratification to see him the father of two healthy 
children.* 

These cases are very frequent, and it becomes the 
surgeon to use the sagacity of an Indian, to elicit the 
truth in some of them, particularly where there is not 
much intelligence. It is quite surprising to know how 
extensively falsehood is used, when communicating with 
the family attendant, of whom there is always more or 
less fear in these cases, especially if he has been intro- 
duced by the wife's relatives. Upon more than one oc- 
casion I have had this admitted to me by patients, with 
out the slightest idea of its folly or impropriety. 

But are we to suspect the husband only ? I fear not, 
Concealment, either from ignorance or design, is often 
found in the other sex. Not long since a friend related 
to me the following case : — A lady, in most respectable 
life, asked his advice respecting a rheumatic affection, 
accompanied with swelling just below the right knee. 
My friend knowing a separation had occurred between 
the patient and her husband, suspected its possible na- 
ture, and on inquiry, found that syphilitic disease had 
been communicated years before. The lady not dream- 
ing of any connection between the existing symptom 
and previous disease, was inexpressibly shocked, but 

* The children in these cases have an appearance of premature 
old age, with wrinkled skin, and copper coloured spots about the anus 
and other contiguous parts : sometimes tho eruption is general. 



68 COMMUNICABLE TO THE CHILD 

wisely submitted to appropriate remedies, and was 
cured. This, of course, was ignorance on the part of 
the patient. 

A far more delicate state of things exists, when the 
wife conceals from her husband and physician, the pos- 
sibility of an affection before marriage. Even this, and 
that too in apparently respectable life, is occasionally 
brought under the notice of the surgeon ; and although 
we ought at all times to let the deportment and connex- 
ions of a patient have their due weight, we should not 
recognize the impossibility of syphilitic taint, from any 
such circumstances. The surgeon is to remember that 
the strongest possible motives are here existing for his 
patient to deceive him. In two instances I have suffer- 
ed my patients distinctly to understand, that I should 
use treatment predicated upon the supposition of sy 
philis existing, and although they had just before made 
the strongest asseveration of its utter impossibility, no 
objection was made to the medicine. I required no 
stronger assurance that they knew my impression to be 
well founded. 

The idea has been thrown out, of the possibility of 
infection from sources such as the ordinary and natural 
mucous secretions of a syphilitic person who had no ul 
ceration whatever ; I now mean years after the prima- 
ry disease, the patient having only the latent taint in the 
blood. This, it will suffice to say, we do not believe; 
and indeed the idea is not now entertained by practical 
men. Though it is communicated to the infant by the 
father, and may, as we have seen, reach the innocent 



BEFORE BIRTH. 69 

mother, by the nipples, it cannot be communicated to 
the mother without ulceration of the genital organ of 
the father, or direct application of the matter of a chancre 
or bubo, by some less probable method. 



CHAPTER XIV. 



TREATMENT OF SYPHILIS. 



After the explicit announcement in the preface on 
the absurdity of self-treatment, it will hardly be sup- 
posed that we intend to give any directions for that pur- 
pose. Our object, the discrimination and avoidance of 
quackery, would not be attained without giving the 
non-professional reader a general idea of the treatment 
in use by professional men. 

Mercury, in some of its forms, is the only medicine 
on which reliance may be placed, and the averment of 
all who promise to cure by any other means, may, in 
the present state of practice, be taken as evidence of 
quackery. We now allude to all cases in which it has 
not previously been given, either by the quack or reg- 
ular surgeon ; for we are well aware of the existence of 
disease, itself caused by the injudicious use of mercury, 
and that too in syphilis. In these cases, tonic medi- 
cines, of which the hydriodate of potass and the iodide 
of iron, may be said to rank highest, are indispensable; 
and whether mercury be resumed at a more auspicious 
period, when the tonics have rendered the system able 
to bear it, must depend entirely upon the good sense of 
the practitioner. 

In a word, we fully coincide with the sentiments of 



TREATMENT OF SYPHILIS. 71 

a large portion of the most intelligent surgeons, that 
mercury, in uncomplicated cases of syphilis, is a spe- 
cific; — nay more, that it operates by actually neutraliz- 
ing the poison, directly upon coming in contact there- 
with. Here we have the high authority of Mr. Bell, 
who entertains this view. And we really think the evi- 
dence would long since have been deemed conclusive, 
could the learned cobwebs, by any possibility, have been 
swept away from the brains of some of our most 
wordy authors. 

The ideas entertained of its curative action, such as its 
operation as a counter irritant, and an evacu«nt, may 
soon be disposed of. The former supposed it to ob- 
literate the disease, by establishing another irritation or 
disease, peculiar to itself. There was an idea formerly 
almost universally prevalent — that two diseases could 
not exist, at the same time, in the human system. This 
is now not only known to be incorrect, but, the reader 
will perceive, it leaves the poison to be got rid of, entire- 
ly by the effort of nature : and this, although it cer- 
tainly has occurred where no treatment was used, would 
in an infinite majority of cases, as all experience proves, 
subject the patient to a sore throat, and constitutional 
eruption ; symptoms that often occur, even when mer- 
cury has been given, but either insufficient in quantity, 
or too rapidly. 

The idea that mercury operates by its" powers as an 
evacuant, in the natural excretory organs, as the bow- 
els, bladder, skin, and salivary glands, was natural 
enough when physicians talked about the necessity of 
salivation in all cases, and that it was necessary that the 



72 TREATMENT OF SYPHILIS. 

mouth, as well as all the other passages of the body, 
41 should run like a river." This is now reprobated by 
all intelligent men. Salivation is never necessary, and 
when it does accidentally occur, owing to the impru- 
dence of either surgeon or patient, 'tis a great misfor- 
tune, and always does mischief. How odd it is, that 
those who held to the doctrine that the poison must "be 
run out of the body," did not reflect, that as it plainly 
showed its wonderful power of infecting, by poisoning 
the whole mass of the blood, although it was a mere 
atom when first applied to the genital organs, it would 
be necessary for all the blood to be removed from the in- 
dividual affected, and an entire new stock supplied- 
And again, every one knows that mercury operates 
most effectually when it produces the least disturbance 
of any kind in the constitution. An expression often 
used by practical surgeons is, " he tolerates mercury 
well, and will do well enough," shows the sentiment 
now universally held by them. 

The inability to distinguish scurvy and the mercurial 
erythema, would undoubtedly be a great misfortune for 
the patient, should he be so unfortunate as to fall into 
the hands of an inexperienced surgeon. As it is not 
our purpose to extend this volume beyond the import 
of its title, we must refer the medical reader to the works 
of Messrs. Abernethy, Alley, and Mathias, as they con- 
tain all that is worth reading on the subject. 

It is scarcely necessary to reason on the manner in 
which mercury cures syphilis ; yet we cannot forbear 
noticing two points, that seem to us rather unanswera- 
ble, as to its specific and neutralizing power. The 



TREATMENT OF SYPHILIS. 73 

first is this — that according to the old method of curing 
bubos, or in other words syphilis, for the reader knows 
that the bubo, when it exists, is the store house whence 
the poison is to go into the blood, mercury was rubbed 
into the absorbents on the front of the thigh, and these 
very vessels form the bubo. Now this often melted 
away the enlarged gland, and they heard no more of 
the poison, — no, not even when they gave no mercury 
by the mouth. No evacuations of any kind were pro- 
duced, and no effect, save the disappearance of the 
bubo, which wc know often produces the whole train of 
symptoms, and, in our experience, without mercury is 
given, always ends by the formation of matter. By 
what agency then, did the mercury resolve these bubos? 
No visible effect — no matter — and yet a complete sub- 
sidence of the bubo. We leave others to theorize ; we 
are content to view it as a neutralizing agent. 

The next point is, that its most beneficial effect is 
produced when it produces no visible disturbance ; in- 
deed, we need not always expect to see the slightest 
redness of the gums, and yet the severest constitutional 
affections disappear ; its action here is equally conclu- 
sive as in bubo ; according to our limited capacity, it 
must be specific or neutralizing. 

The non-mercurial treatment of syphilis, is adorned 
with names so distinguished in the annals of hospital 
surgery, both here and in Europe, that it would ill be- 
come us to pass it without notice ; and yet it is only our 
purpose to remark, that although there is undoubted 
evidence, to show that syphilis has disappeared without 
the administration of mercury, when the patient has 
7 



74 TREATMENT OF SYPU1LIS. 

submitted from the beginning to rigid control in his gen 
eral regimen, still a very large proportion of these pa- 
tients had secondary symptoms ; and that is what pa- 
tients, such as present themselves to us in the latitude of 
New- York, are very unwilling to endure. 

Moreover, from the discursive and migratory habits 
of hospital patients generally, the gentlemen who made 
those experiments, could not have had the opportunity 
of knowing in how many the disease returned, after the 
cure was supposed to have been effected. There can 
be no doubt of the expediency of administering mercury 
in some form, as the best and only certain means of 
cure. 

There are a variety of wonderful decoctions, in old 
authors, and some of them have found their way into 
the hands of quacks, and are heralded as " certain cures 
without mercury:" these originated at a time, when the 
process of cure was entirely conducted without mercury. 
This remedy was introduced in 1516. I believe that I 
utter the sentiment of the entire profession in this city, 
in saying that all who recovered, escaped the disease 
by the powers of nature alone; nothing then used, 
could have effected anything in curing the disease: 
very possibly some of them had a partial effect in sup- 
porting the system, but as to curative power they were 
utterly inert. 

Some of these compounds could almost shame the 
witches in Macbeth for the meagerness of their inven- 
tion : true ve do not read of " eye of newt, or toe of 
frog," nor " liver of blaspheming jew," but the whole 
vegetable kingdom wae ransacked, to " make the hell- 



TKEATMENT OF SYPHILIS. 75 

broth thick and slab," and heaven help the poor wretch- 
es, who even now are doomed by quacks to swallow 
such messes. As for ointments, the " unguentum 
apostolorum," so called because it contained twelve in- 
gredients, was quite a small affair to some that are 
gravely set forth as working wonders : indeed, it would 
be time lost to attempt an enumeration of these worth- 
less compounds : air, earth, and ocean, were ransacked 
to find them, and there can be no doubt that nature 
was greatly impeded in her effort to cure, and thousands 
were sacrificed at the shrine of quackery. Would to 
God it had ceased with those times. 

There are some hundreds of mercurial preparations, 
yet it is now well known, that but two or three merit 
the attention of the practitioner, either for uniformity of 
action or efficiency in small quantity ; a most import- 
ant quality, as some stomachs are so intolerant of 
mercury, as to be unable to bear it at all, compelling us 
to introduce it by the absorbents, or rubbing it through 
the skin. 

There is also a method of introducing it through the 
skin in the form of vapour, by enclosing the body of the 
patient either in a box or tent, and suffering the head 
to project; then burning a preparation of mercury with- 
in it, on live coals : this method is now seldom used, as 
few patients will submit to the necessary trouble of ar- 
ranging the apparatus, yet it has the advantage of act- 
ing with great rapidity, and is useful when imminent 
danger threatens the palate with ulceration ; it some- 
times checks this symptom very rapidly. This method 
was proposed in 1776, by the Chevalier Lalouette of 



76 TREATMENT OF SYPHILIS. 

Paris, and was strongly supported by Mr. Abernethy 
of London. The writer has found it of great use in 
stubborn local ulcers, that evince a very slow disposition 
to heal, even when the constitution is under the action 
of mercury ; in these cases it is an admirable adjunct, 
but is now seldom used in this city as a means of mer- 
curializing the system. 

The means used by the author of thus applying it, 
consists of a small tight tin closet about a foot square, 
containing room for a chafing dish of coals, on which a 
few grains of the red sulphuret of quicksilver is sprin 
kled ; the fumes are directed to the sore by means of a 
flexible tube, its sides being held apart by a spiral wire ; 
the mouth of this encircles the sore, resting upon the 
surrounding skin. We never apply this method to the 
body generally, unless the eruption is uncommonly ob 
stinate and extensive ; it should be used sparingly al 
ways, as it is impossible to estimate its effect, when 
used in conjunction with the internal administration of 
mercury. 

We have mentioned this method first, not because it 
is the most, but the least important. The two meth- 
ods most in use, are inunction, or rubbing mercurial 
ointment through the skin, and the administration by the 
.nouth. 

Inunction has the great advantage of producing the 
least disturbance. As it does not go into the stomach 
and bowels, it can produce no disturbance of them, un- 
less very long continued, or used in too great quantity, 
when it may affect them secondarily. This is the old* 
est method of cure. 



TREATMENT OF SYPHILIS. 77 

The objection to it is, that it is more troublesome 
and as very few will submit to confinement : in the great 
majority of cases, having no eruption, they insist upon 
going about, and taking medicine by the mouth. When 
the method is adopted, a scruple of the mild mercurial 
ointment is to be rubbed into the front of the thigh, 
twice or thrice a day. It should always be done by the 
patient himself, as any other person would render him- 
self liable to salivation, by absorbing the ointment 
through the skin of the hands. It acts with more cer- 
tainty, if during the process the patient be kept in a per- 
fectly equal and mild temperature. The front of the 
thigh is chosen, not only from its facility of access, but 
from the fact of the absorbents passing directly into the 
bubo, should there happen to be one, thus curing it at 
once. 

It occasionally happens, that the friction itself pro- 
duces a bubo, should there be no chancre, that having 
been previously cured, and the ointment being used for 
constitutional symptoms. The patient will remember, 
that this oubo cannot be syphilitic. It is only sympa- 
thetic, as surgeons say, or in other words, produced by 
irritation, as when it occurs from a wound of the 
toe or foot, and also, as the reader will see, in gonorr- 
hea, They rarely suppurate, and will subside on leav- 
ing off tne frictions, using the other thigh, or the arms 
for that purpose. From three to five weeks may be re- 
quired in this process of cure, the surgeon not deem- 
ing it expedient to risk the re-ay pearance of the dis- 
ease, with less application of the means. 

During the use of inunction, no other means should 
7 # 



78 TREATMENT OF SYPHILIS. 

be used, as it would otherwise be impossible to estimate 
the amount of mercury introduced, and a distressing 
salivation might be the consequence. The surgeon wil! 
be governed in the length of time for using it, entirely 
by the appearance of the constitutional eruption, or 
bubo, for which it is used. It shows its action by ten- 
derness of the gums, and metallic taste in the mouth, 
and should then be discontinued for a while at least, to 
be resumed should the symptoms warrant it. 

When the method of medication, by inward use is 
adopted, the preparations most in use are the Pill. Mass. 
Hydrarg., Hydrarg. Chlorid. Mite., or the Hydrarg. 
Chlorid. Corrosiv. of the United States Pharmacopeia. 
The intelligent reader will at once see the impropriety 
of being more explicit, in a work designed for popular 
instruction. Though he would make no improper use 
of a more distinct announcement, there are many who 
would, and thus great mischief would ensue. So far 
as the opinion of the author goes, he is at a loss to give 
one the preference over the other. If there be any dif- 
ference, the first is the mildest, the second less mild, 
and the third the most active. They all require to be 
combined with a small quantity of opium, when used 
in the customary doses, always chosen when constitu- 
tional effects are designed. 

The pills of the last are much the smallest ; probably 
for that reason it is most used in this city. The follow- 
ing formula is added for the professional reader : 

R. Hydrararg. Chlor. Corrosiv. 
Muriatis Ammon — aa — gr. xv. 
Aq. Distillat vel. font — 3iss — solut. adde. 



TREATMENT OP SYPHILIS. 79 

Panis Metlul. sic. — q. s. 

Ut. fiat — Mass. in pill cxx. dividenda. 

These may be given according to the intensity of the 
constitutional affection twice or thrice a day. Should 
they evince a tendency to irritate the bowels, a pill of 
one-fourth of a grain of opium may occasionally be 
given. The other two preparations may be used in 
the ordinary doses, with which every practitioner is 
familiar. 

I shall say very little of local applications, because I 
have very little confidence in any great variety. Greasy 
dressings are for the most part injurious. The ni- 
trate of silver, sulphate of copper, and dry cantharides, 
with the black, and yellow wash, or dry calomel, will 
effect all the practitioner can desire, — the former either 
as a corrosive or stimulating agent, and the others either 
as stimulants or alteratives. The writer uses the nitrate 
almost exclusively for all these purposes, governing the 
strength of the application by the effect intended, whe- 
ther on chancre, ulcer, or bubo. 

1 have said nothing as yet on the treatment of what 
are called tertiary symptoms. These consist of all those 
enumerated after the affections of the skin and throat. 
Although this is strictly the professional meaning, the 
popular one may be said to be, the persisting symp- 
toms — I mean all those occurring after treatment, regu- 
lar or empyrical, has either ceased, or ought to have 
ceased. 

If I were to state the sentiments of the most thought- 
ful and observant of the profession, I should say that it 
is impossible to separate the symptoms of this stage from 



80 TREATMENT OP SYPHILIS. 

the specific effects of the disease and the mercury ; and 
I most candidly add, that these are my own views, not- 
withstanding the freedom with which I have asserted 
that mercury is a necessary, nay, an utterly indispensa- 
ble medicine in its treatment. 

A man can only be answerable for his own errors ; 
and I look back with regret upon many that L have com- 
mitted, in prescribing for syphilitic patients by rule, as 
promulgated in our colleges. There is no rule by which 
every man is to be treated. Like the varied powers of 
resistance in the substances surrounding us, every man 
has his capacity to resist disease for a certain time. 
Would to God he had equal capacity to resist bad treat- 
ment. Yet nature, more merciful than the quack, even 
in the infliction of evils, does it after a plan, — some 
warning is given by which to avoid them, if a proper 
use of the senses are made. 

Not so with the medicine giver. He has but one rule, 
which may thus be rendered : " If a little is serviceable, 
a great deal is more so." All temperaments are alike to 
him. The great mass of animal life, that lives but to 
eat and sleep, who has no thought for the morrow, and 
the poor attenuated bundle of nerves, whose every day 
brings its burden of care and sorrow, — the broken down 
libertine, the delicate and scrofulous youth, — all are 
subjected to the same indiscriminate and powerful me- 
dication, and for an equal length of time. Mercury is it- 
self a most potent irritant, as is evinced by the nervous 
agitation, the sleeplessness, the thready pulse, that fol- 
lows its continued use. Yet this is no caution to the 
quack, — he goes on until the energies of the system are 



TREATMENT OP SYPHILIS. 81 

completely prostrated, and either actual mercurial dis- 
ease shall supervene, or in the end, the whole train of 
calamities, succeeded by exfoliation of the bones, takes 
place. 

It is under these circumstances that the great gift of 
chemistry to medicine, the hydriodate of potass, will 
effect the most extraordinary benefit. And the practi- 
tioner who becomes early convinced of this will be most 
likely to save his patient from a loathsome and linger- 
ing death. 

Whilst treating this subject, it will be observed we 
have made no especial* reference to the female. There 
is no necessity for any difference in treatment, with the 
exception of the mode of examination and the applica- 
tion of remedies. This must be done entirely through 
the medium of the speculum, to all chancres within the 
vagina. The most difficult cases, and it is very com- 
mon to find them, are met with where chancres exist on 
the neck of the womb. And as practitioners generally 
will not take the trouble, and many are without the neces- 
sary instruments for examination, these prove exceed- 
ingly obstinate, and long resist constitutional treatment. 
The warmth and moisture of the part is the great cause 
of this. They require additional stimulus to overcome 
the relaxing effects of their position. The nitrate of 
silver will effect the most rapid and favourable change. 

The writer hopes he will be excused for his attach- 
ment to a bantling ef his own , He cannot here avoid 
saying what has been said in a manner far more grati- 
fying to his feelings by others: that the speculum 
invented and described by him in Vol. xxx. No. 1, of 



TREATMENT OF SYPHILIS. 



the Boston Medical and Surgical Journal, is the most. 
efficient instrument, and can be applied without the 
slightest pain to the most delicate female. 



CHAPTER XV. 

ON THE DURATION OP A MERCURIAL COURSE. 

It will doubtless be expected that something should 
be said upon the amount of mercury to be given: noth- 
ing could be more gratifying to the feelings of every 
man who has a proper estimate of professional truth, 
than to be able to say in the infinite variety of condi- 
tions, in which he is compelled to use this powerful 
article, when it has effected its entire object ; when the 
last particle of the poison was thoroughly extinguished, 
and a certain immunity produced. His professional 
experience is constanly teaching him, that errors are 
committed by his patient in his general regimen ; no 
matter how strictly he may lay his injunctions, his best 
efforts are constantly thwarted by his patient's folly, and 
his skill and anxiety set at naught. 

Whatever the method by which mercury actually 
cures syphilis, all agree that it produces its happiest 
effect, under the most quiet and equable regimen ; 
whether the delicacy of our patient demand the simulta- 
neous use of tonics and nourishing food, or his vigour 
and plethora compel us to adopt the severer rules of 
diatetics ; hence it is that even in the latter case, we are 
to effect by the strictest injunction of the simplest diet, 
that reduction of the inflammatory state of the system, 



84 ON THE DURATION OF 

we could not venture to produce by the more violent 
means of the lancet or purgatives : for the moment we 
use either of these, during the mercurial course, we ren- 
der him liable, by disturbing the mucous membrane of (lie 
stomach and bowels, to the rapid absorption of the med- 
icine, and immediate salivation : this it is by no means 
desirable to do : nay, as we have said before, it is a great 
misfortune. 

We seek to introduce the medicine with the least pos- 
sible disturbance, and to make our patient " tolerate 
it" till the subsidence of the constitutional symptom for 
which it is given, shall show that it has quietly effected 
its end ; when this has occurred, whether for a bubo, a 
general eruption, or sore throat, the prudent surgeon will 
not immediately discontinue entirely its use, but watching 
most carefully the gums, and being emphatic with his 
patient on the subject of dress, reduce the quantity one- 
half, and if he bears it well, continue for a fortnight 
longer. 

This is the way to avoid the re-appearance of consti- 
tutional symptoms, notwithstanding the occasional re- 
marks of the designing and ignorant, either in or out of 
the profession. I am perfectly willing to say, that in 
earlier professional life I often erred from my apprehen- 
sions of mercury ; that apprehension still continues : for 
I well know its danger, from the excessive irregularity 
of young men in everything that relates to a rational and 
philosophical mode of life : and I also know the fre- 
quency with which they visit the consequences of their 
errors upon their surgeon : all this produces no effect 
upon the man who means to exercise his best efforts for 



A MERCURIAL COURSE. 85 

his own reputation, and his patient's benefit. The sur- 
geon should tell his patient honestly the effect of mid- 
night debauchery and absurd dress, and then constantly 
remind him of it roundly, regardless of his feelings : 
there is no room for feeling in the matter ; it is the ex- 
ercise of judgment and common sense that is wanting, 
and no man should permit his patient to trifle with his 
reputation, whatever he may do with his own health. 

A patient who is taking mercury and pursuing his 
ordinary avocations, should exercise such precautions in 
dress, as to ensure a perfectly comfortable state of the 
skin at all times ; with the exception of the months from 
the conclusion of May till the first of October, this can- 
not be done in our climate, without flannel worn either 
next the skin, or thin muslin (never linen) intervening. 
The feet must be protected entirely from dampness, and 
all drafts of air must be avoided. 

The diet must be perfectly regular : every young man 
of common sense knows what will derange his own pe- 
culiar system ; this he must avoid, whatever the induce- 
ment to indulge, for if it derange the stomach and bow- 
els, there must be derangement in the action of the 
medicine. From four to six weeks will usually effect 
the disappearance of most constitutional symptoms in 
first cases ; but where a patient has been often affected, 
and more especially if he should have disease of the 
bones, there can be no rule whatever, as to the time it 
will take to remove the symptoms : he should present 
himself occasionally during some weeks after his treat- 
ment is discontinued, and his physician will then be able 
to anticipate evil, if any should threaten. This is all 
8 



BO ON THE DURATION OP 

that can with any propriety be said on the subject of 
treatment, in a volume like this ; more, the true physi- 
cian does not need : he has his authorities, to whom he 
can refer with confidence, whilst his own practical ex- 
perience is sufficient to guide him to avoid error. We 
trust enough has been said to enable the patient to avoid 
the quack as he would a pestilence. 

In reviewing the horrors of this dreadful disease, it 
would seem as though the author of existence had inter- 
posed it between the passions of man, and the certainty 
of her end being foiled by promiscuous intercourse of 
the sexes ; what would be the result were it not so ? 
How many of the human family, with the fiercest of all 
passions raging in their breasts, and their impulses un- 
restrained by religion or philosophy, would be desolating 
the happiness of millions of delicate beings, whose phys- 
ical structure demands the aid of manhood to sustain 
her, and enable her to endure the ills attendant upon 
her peculiar position in life, without the necessity of la- 
bouring for bread to feed the unconscious child, that 
would add so largely to her misery. What a fearful in- 
centive to crime ! Can it be supposed that the guilty 
beings, who would thus bring children into the world, 
would desire the continued existence of the little gentle 
things, who can only repay a mother's love by the sweet 
smile of infantile innocence 1 No ! they would curse 
the innocent creatures who stood in the way of their vo- 
cation, and ere long, if not by neglect, would effect their 
death by more horrid means. 

Wisely indeed have the medico-legal jurists of Ger- 
many, when called on to investigate a case of infanti- 



A MERCURIAL COURSE. 87 

cide, agreed to receive the proof of a mother's not hav- 
ing provided clothes for her expected offspring, as strong 
evidence of her participation in its death. The birds 
of the air, the beasts of the field, all show this predomi- 
nant law of nature, by providing shelter for their young, 
and the inference is wisely drawn by medico-legal wri- 
*&$, that inattention to so universal an instinct, is prima 
facie evidence of guilt. 

A minor degree of this passion, according to the con 
stitution of nature, must ever exist with those whose 
physical strength is brought into requisition for the pro- 
tection of their offspring ; and I cannot withhold my 
opinion, that the man who voluntarily withdraws him- 
self from the society of the sex who still retain the dig- 
nity and sanctity of virtue, and prostitutes the gentler 
affections of his nature at the shrine of the harlot, gives 
to the world the most palpable evidence of a total 
absence of virtue, and all the graces and poetry of 
manhood. 



ON GO NORRHE A 



CHAPTER I. 



GONORRHEA. 



The mucous membrance that lines the cavity of the 
nose, mouth, and lungs, is liable, as the reader well 
knows, to a species of disease derived from changes in 
the atmosphere, called catarrh, or a cold : it is charac- 
terized by a discharge of mucus and matter, of various 
degrees of consistence, and after continuing an indefi- 
nite time disappears by the powers of nature alone. 

In like manner the mucous membrane of the bladder 
and private parts of both sexes, which is precisely simi- 
lar in structure to that of the mouth and lungs, is sub- 
ject to inflammation from various causes, followed by 
effects precisely similar, although from the stimulating 
and acrid nature of the urine, and the different functions 
of the parts, the disease rarely terminates favourably 
without active medical aid. This is often called catarrh 
of the bladder. 

By far the most frequent cause, however, of inflam- 
mation of the mucous membrane of the genital organs, 
is, the application of the specific matter of gonorrhea, 
occurring in coition ; we have made the comparison to 
the lungs, because it will give the reader a very accu- 
rate and familiar illustration of its general nature, and 
greatly aid us in our explanation of the principal symp- 



92 



GONORRHEA. 



torn, viz : the discharge of quantities of matter without 
ulceration. We know no more of the origin of gonor- 
rhea, than of syphilis : it has attracted less investigation, 
because it does not affect the system so seriously as 
syphilis ; nor do those loathsome affections of the bones, 
nor ulcerations and eruptions, follow it ; neither can it 
be transmitted to posterity, even if existing at the time 
of their pro-creation ; in short, it is confined entirely to 
the genital organs, and does not affect the blood, though 
it is highly contagious. As to the period of its origin, 
we have nothing definite in the books, beyond the time of 
Moses: see Leviticus, chap, xv.: the same reasoning with 
regard to the manner, will doubtless apply to both dis- 
eases : that it should differ entirely in its nature, is 
just as natural as that the same earth should produce 
different products. 

It is, when we consider the wide difference in the 
symptoms and effects of the two diseases, it is almost in- 
explicable that they should ever have been supposed iden- 
tical ; and it is still more astonishing that so great a man 
as John Hunter, should have held this doctrine. The 
one almost invariably proceeding to the affection of the 
constitution, unless checked by the use of mercury, the 
other never requiring it, and never producing constitu- 
tional affections that would not disappear without any 
treatment whatever. The chancre almost invariably 
producing its like, and the discharge from gonorrhea 
never producing chancre, but a similar affection to it- 
self. The occasional appearance of chancre in those 
who have gonorrhea is now completely accounted for 
by the frequent existence of both diseases at once ; and 



GONORRHEA. 93 

the chancre concealed within the urethra or vagina, ac- 
counts for constitutional symptoms in those supposed to 
have only gonorrhea. The appearance of bubos, as 
well as slight constitutional eruptions, may easily be 
known not to be syphilitic by their sudden disap- 
pearance without treatment, an event rarely occurring 
in syphilis. Finally, should not the two diseases, if 
identical, have been constantly merging into one an- 
other, so that it would have been impossible to form any 
judgment respecting their treatment or progress? Yet 
even this was supposed to occur, for it was a common 
impression that gonorrhea suddenly checked would 
produce syphilis, and mercury was given for both. 

The reader must likewise remember, that as there is no 
definite period after coition for the occurrence of chancre 
or gonorrhea, the one may supervene unexpectedly up- 
on the other, the contagious matter existing, but from 
some unknown cause not being lighted into action, both 
the poisons being received at the same time : and again, 
the one poison may be received by a subsequent coition 
during the existence of the other. There is, as was re- 
marked when treating of chancre, a general excoriation 
of the glands occurring in gonorrhea, that to the inex- 
perienced looks like an extensive chancre ; it is the re- 
sult of great tenderness of the cuticle, causing the dis- 
charge of gonorrhea to prove more irritating than usual : 
this often causes unnecessary anxiety. 

The existence of gonorrhea and chancre simultaneous- 
ly, I have several times noticed, and known them, in one 
instance at least, to have been contracted from the same 
woman by two persons ; and in another instance, one in- 



04 



GONORRHEA. 



dividual had gonorrhea, and the other chancre, though 
neither had connexion with any other woman for a long 
time previous ; both of these persons had been my pa- 
tients for a long time, and I had their entire confidence. 
Through the kindness of her attending surgeon, the 
writer satisfied himself of the existence of both diseases 
in tliis woman : a violent gonorrhea existed, and by the 
speculum we ascertained the presence of chancres ou 
the neck of the womb. 

The remedies used in gonorrhea with success, have 
no effect whatever upon syphilis ; and mercurials, as 
they are used in the latter, do not benefit the former in 
the slightest degree. This, it seems to us, should be 
conclusive. The term gonorrhea, is derived from two 
Greek words, yov^, the semen, and pfw, to flow ; by 
which it appears to be decidedly incorrect, as there is 
no semen, but mucus and matter flowing from the penis. 
Nevertheless, we shall retain that term as usage has 
sanctioned it. 

The disease is vulgarly called clap, from the old 
French word clapises, or houses of prostitution, occu- 
pied by single prostitutes. In French, it is also called 
chandpisse, from the scalding ill passing water. In 
German, a tripper, from the dripping. 

Although the discharge called gonorrhea, does al- 
most invariably originate from direct contact with an in- 
fected person, still it may be produced by an altered se- 
cretion of the mucus membrane of the vagina, in per- 
sons who are perfectly virtuous. I have known several 
instances in which, from the character of the parties, 
there was no reason to suspect that the husband had re- 



GONORRHEA. 95 

ceived the infection from any other source than a very 
bad leucorrhea] discharge, existing in the wife. I 
am well aware of the necessary incredulity to be used in 
these matters, yet where I have had the entire confi- 
dence of both patients, T am quite satisfied of such a 
result being possible. Moreover, the idea is entertained 
by many experienced practitioners in this city, and is 
reconcilable to all analogy. 

Atmospheric causes will, I am also satisfied, produce 
a violent discharge from the urethra, accompanied with 
great scalding in passing water and chordee. Whether 
this will inoculate a healthy person with the same dis- 
ease, I am unable to say, as I have always urged cau- 
tion in those who were thus affected. 

1 have several times been consulted by boatmen and 
raftmen, whose occupations exposed them to the weath- 
er, and who had certainly no moral reasons for con- 
cealment. They have had all the symptoms of clap, 
after long exposure to wet feet and cold weather. I 
know a gentleman in this city, who never gets wet feet 
without this result, and I have a most incredulous med- 
ical friend, who has another patient subject to the like 
annoyance. 

I would not be misunderstood. I believe that ninety 
nine out of a hundred claps originate in the legitimate 
way, and the more anxious my patient is to convince 
me, as they often do attempt, that he got his disease in 
a privy, or in some other than the natural way, the 
more I am satisfied he endeavours to deceive me. Yet 
every man of experience can discriminate between these 
persons. I know cases in which I should be sorry to 



9b GONORRHEA 

believe the most solemn asseveration of persons, whose 
word in trifling matters might be depended on. Yet 
where character is concerned they are not to be believ- 
ed, if interested in deceiving. Patients often take 
an unnecessary amount of trouble in these cases, for 
surgeons are the receivers of many secrets, and they 
generally keep them so long, that they forget where 
they are. 

There is no definite period after an impure connex- 
ion, for the discharge to show itself. A few hours, or 
six weeks may elapse, before the discharge appears. 
From the third to the eighth day is the most common 
period. Much depends upon the susceptibility of the 
jfatient's temperament, and his manner of living at the 
time. 

The first symptom that appears is uneasiness in the 
end of the penis, accompanied with perhaps the light- 
est redness, and difficulty in passing water, the stream 
being slightly contracted. There is no invariable col- 
our to the first discharge. It is often white, straw col- 
our, turbid, and rarely bloody. This is accompanied 
with tenderness upon touching the part immediately by 
the redness. These symptoms may be accompanied 
with scalding in urinating, or that symptom may be de- 
layed a day or two. The discharge comes not over an 
inch from the end of the penis. 

The writer cannot forbear expressing his surprise, 
that there should be any practitioners willing to pass by 
this stage with the trifling treatment often adopted. If 
there be any truth in practical experience, in nine cases 
out of ten, should the patient apply on the first or sec- 



OONORR.HEA. 97 

ond day, the disease may be at once arrested, and 
weeks of annoyance saved. An injection of from five 
to twenty grains of the nitrate, according to the physi- 
que of the patient, and retained from one to five min- 
utes, will generally effect the cure. It should be in- 
troduced with the glass syringe, the fingers being 
pressed upon the urethra, two inches from the end of 
the penis. There is no doubt that the timidity of the 
practitioner often prevents the use of this remedy. I am 
happy to see, however, a greater distrust in medicine, 
and a growing reliance on local medication. 

In these cases we are not to ask the patient's advice, 
or to consult his wishes. We are to act for him. He 
knows nothing about the annoyance of asix weeks orthree 
months' siege, and then a stricture to boot. The popu- 
lar notion that injections cause strictures, is well known 
by every practical man to be false. They prevent them, 
by rapidly curing the disease, and thus stopping the ef- 
fusion of lymph. 

I would not have it supposed that this powerful treat- 
ment is to be adopted without due attention to regimen. 
On the contrary, the physician must have entire control 
)f the patient, if the radical cure is to be adopted. He 
must be directed to keep his chamber, and consent to 
live, for a few days, on six crackers and a glass of water 
per day. The circulation must be kept down, com- 
pletely, and in cold weather this is peculiarly necessary. 
Should the first injection prevent the passage of water 
for a few hours, it is of no consequence ; it will gradu- 
ally pass off. If on the second day after the use of the 
remedy, the discharge should be almost suppressed, it 
9 



98 



GONORRHEA. 



may be again used, of half the strength first applied, 
and its further continuance will rarely be necessary. 

I have left it to the discretion of the practitioner, 
whether to use this injection of five or twenty grains. 
The effect, the reader may be assured, will prove most 
emphatically different, if used the full strength, and I do 
most cordially advise him not to meddle with it himself, 
as he might be grievously disappointed in the result. 
Temperament, and the period of the disease, is to gov- 
ern us entirely in its use. When we have the advan- 
tage of a patient who has had much experience in the 
use of remedies, we can profitably avail ourselves of it 
in conducting the treatment. A nervous temperament 
will be most sensibly impressed by the remedy, if used 
half the strength of a scruple, whilst a lymphatic one 
will easily bear that quantity. 

It is impossible to define the stages of gonorrhea by 
number of days. Should our attempt at a cure fail, or 
should the patient be submitted to no treatment, the 
second stage may appear after a week — rarely sooner. 
If the patient be fortunate enough to have the dis- 
charge checked, he is most distinctly to remember, that 
all kinds of liquor, hearty food, spices, chills, coition, 
and wet feet will, nine times out of ten, bring it on 
again, when the second stage will appear ; but as that 
requires totally different treatment, we refer him to the 
next chapter. 



CHAPTER II. 

SECOND STAGE. 

We have proceeded so far upon the principle of en- 
tire control of our patient ; nevertheless, we are well 
aware that this is rarely possible, the patient either be- 
ing compelled, or supposing himself to be obliged to 
attend his ordinary business. Still we should attempt 
the radical cure, as well as circumstances admit, and we 
shall often be successful. 

The second stage may be known by violent scalding 
in urinating, chordee, or a constant persistence in the 
penis to become erected, with partial inability, from the 
inflammation and construction of its lower part, and an 
increased and often profuse discharge of greenish mat- 
ter, often tinged with blood, coming from a much greater 
distance down the urethra. When this stage is fairly 
established, the matter comes from as far down as the 
scrotum, where there are some small glands that have 
ducts leading into the urethra. These often become en- 
larged, and may be felt outside the skin. There is 
more or less pain in the back and loins. It is the nat- 
ural tendency of this poison to extend along the lining 
and mucous membrane of the urethra, if no treatment 
is used. 

Those who are not familiar with practice of thi3 



100 GONORRHEA. 

kind, occasionally find it convenient, for various rea- 
sons, ignorance perhaps, to say that injections aggra- 
vate these symptoms. So they undoubtedly would, if 
continued in this stage, but if applied for a radical cure, 
they never can, when used before there is much scald- 
ing. The analogy between the mucous membrane of 
the throat and penis, is perfect, and we all know that 
the pure nitrate is often applied, when local inflamma- 
tions are forming there, with the effect of stopping them 
immediately. The same practice applies to the eye, 
where the most violent inflammation — nay, that actually 
produced by the application of gonorrheal matter itself 
— is often at once obliterated by the same agent. 

In this stage injections of no kind are to be thought 
of. Stimulating ones would greatly aggravate the in- 
flammation, and increase all the bad symptoms ; and 
soothing ones, as they are called, are child's play, — they 
can do no possible good, and the irritation of the syringe 
will do harm. 

The whole body of the penis may be affected in this 
stage, and abscesses may even form. These should be 
opened, as soon as matter is detected, before they break 
into the urethra, as in that event, the urine would find 
its way into the substance of the penis, and produce dis- 
tressing results. Should the patient object to this, or 
the surgeon delay the puncture, the abscess may break 
both externally and internally, producing a disease we 
shall have occasion to speak of hereafter. Suffice it to 
say here, should this occur, it will so far emasculate the 
patient, as in all likelihood to hinder him from pro- 
creating. 



SECOND STAGE. 101 

The first step to be taken in this stage, is to direct 
ijrofound rest of body. The patient, if at all inclined 
to fulness, should be bled, decisively, and leeches ap- 
plied along the penis. The diet should be low. For 
the ardor urime, or scalding, there is no remedy like 
the Liquor Potassae, 30 drops in half a tumbler of 
water twice or thrice a day, according to the urgency 
of the symptoms. Tn those whose habit of body, or 
constitutional affections, as of the lungs, &c, may ren- 
der bleeding improper, nauseating doses of antimony 
are useful. The antimony may be combined with salts, 
as an emetico cathartic, should purging be desirable. 

Some authors recommend blisters over the perinaeum. 
I have never tried them from a conviction that they 
must irritate excessively, and do harm ; leeches are 
always preferable. Holding the penis in warm wate 
is sometimes resorted to with partial relief of pain, which 
is the precursor of chordee. This symptom is often ex- 
cessively painful, and is the greatest evil the patient has 
to endure in gonorrhea. There is no remedy like laud- 
anum, fifty drops of which may be given by the mouth, 
and a pill of belladonna, hyosciamus, or camphor, de- 
posited in the rectum. The hyosciamus is often given 
by the mouth, but it requires caution, as it is poisonous. 
It should only be given by the physician. A laxative 
of oil will often benefit chordee. A symptom that 
astonishes and alarms the patient in this stage is, the 
abundant secretion of matter ; he concludes that this 
implies disorganization or ulceration of the parts whence 
it comes ; but he has only to remember what profuse 
discharges of matter occur in ordinary catarrh, when 
9* 



102 GONORRHEA. 

extensively affecting the mucous membrane of the lungs; 
and where there is no disorganization, or death would 
often ensue, as in consumption, where there is destruc- 
tion of parts ; this matter is secreted or produced, by 
the mucous membrane of the lungs and penis, from the 
blood : there is no ulceration whatever, but simply in- 
flammation. After all the inflammatory symptoms are 
subdued, the remedies now most in use are the balsam co- 
paiba and cubebs. I shall say no more of their appli- 
cation here, as I shall have occasion to speak of them 
again ; whenever they are proper, they are always to be 
used in a similar manner. The patient will already ob- 
serve that although the blood is not poisoned in gonor- 
hea, it is attended with far more distressing results, to 
his comfort at least, than most cases of syphilis : as a 
general rule, a practitioner would rather treat ten cases 
of syphilis, than one second, or subsequent stage of 
gonorrhea. 



CHAPTER III. 



THIRD STAGE. 



Authors frequently divide the remaining symptoms 
of the disease into two stages ; but as they comprise af- 
fections of the bladder, and its appendages, exclusively, 
1 shall include them in one. This stage commences 
when the inflammation has reached the lowest part of 
the urethra, just as it enters the bladder. Surrounding 
this part of that passage, and lying upon the bladder, 
in front of the anus, there is a gland of the size and 
shape of the largest chestnut, which has ten or twelve 
ducts opening into the urethra. On either side of it, lie 
the receptacles for the semen, each of which sends Jts 
own duct into the urethra, immediately in front of the 
prostate gland. 

It is the inflammation, extending through this gland, 
and thus irritating the neck of the bladder, that causes 
the distressing desire to pass water ; and because of its 
contiguity to the rectum, the irritation is extended to 
that, and the patient is constantly trying to pass the 
contents of the bowels, but is unable to effect it. This 
is called tenesmus. Nothing can be more distressing 
than the condition of one thus situated. From the bed 
to the stool, and back again, continually, often with 
constant pains and chordee. Ah me ! says he, if I ever 



104 GONORRHEA. 

get in this way again ! He sends for his surgeon, and 
on his entrance of course com pi ah is bitterly. The sur- 
geon, having possibly left him comfortable, inquires 
what he has been eating. The reply is, "nothing," of 
course. Upon inquiry, systematically however, he had 
ventured to take a glass of wine, or a little ale ! This 
is a common affair to the practical surgeon, and well 
does he know the trouble of disobedient patients. 

Those who are not familiar with these cases, proceed 
to make examinations, thrusting their finger into the 
rectum, to feel the prostate gland, and perhaps a 
catheter into the urethra, to draw oft' the water. God 
help the patient ; 'tis all unnecessary. The practical 
man does no such thing, but bleeds his patient, unless 
there are good reasons to the contrary. If so, he ap- 
plies leeches plentifully, twenty or thirty at least, and 
half that number, if he does bleed, is good practice. 
Fifty drops of laudanum, in a wine glass full of warm 
water, may be thrown up the rectum, and if that will 
not stay, a pill of opium may be deposited there. This 
will control the tenesmus and chordee. 

I have often known this state of things Drought on by 
pottering with injections. They arc all wrong, whether 
astringent, emollient, or sedative. All the good that 
can possibly be done by injections, even theoretically, 
(we denounce the practice utterly in this stage) is much 
better effected by depositing them into the rectum. The 
mechanical irritation of the syringe is highly injurious, 
and the presence of the mildest injection likewise, and 
long before its sedative action commences it is expelled, 
from the annoyance of its distension. Those who wish 



THIRD STAGE. 105 

to be doing something extra, and we know there are 
too many such, had much better envelope the penis in 
cloths wet with laudanum, or solution of belladonna. 
Injections in the urethra, in short, we deem utterly in- 
applicable to this stage, or any other, where the symp- 
toms of prostatic irritation, much scalding, or pain in the 
testicles prevail. 

The diet, in this condition of things, must be very 
light. Toast and tea, or rice, and a soft egg, and an 
oyster, without any butter or spice, is the highest nour- 
ishment admissable, until the urgent symptoms subside. 
I have no confidence whatever in what are called de- 
mulcent drinks, such as gum water, flax seed tea, de- 
coction of mallows, althea, &c. 

It happens unfortunately in some scrofulous cases, 
that swelling of the prostate gland is very slow to sub- 
side, and it may remain permanently enlarged. The 
treatment adapted to these cases is very various, and 
cannot properly find a place here. It is observed that 
matter rarely forms in this part. Upon one occasion 
the writer was requested, by Dr. Bancker, of this city, 
to operate upon a patient, who had the most extensive 
disease, all centering here, he ever witnessed. No less 
than seven distinct sinuses, or false passages for urine, 
had been produced from the neck of the bladder, in 
consequence of obstruction in the gland. They were 
all laid open, and a cure was fortunately the result. We 
say fortunately, for in such an extensive affection, it 
was not reasonably to be expected. This case is re- 
ported at length in the Boston Medical and Surgical 
Journal. 



106 GONORRHEA. 

There are several smaller glands lying near the 
urethra, in front of the prostate, called Cowper's glands, 
from the name of their discoverer. These are quite lia- 
ble to suppurate, and I have seen several instances 
where they made their way into the urethra, and also 
through the skin, thus forming that distressing state 
of things termed perineal fistula, or a false passage into 
the urethra, through which the urine passes, involunta- 
rily, whenever a call is made to expel the contents of the 
bladder. These may often be detected, by great care, 
before they burst into the urethra. By an external open- 
ing, the surgeon may save his patient great distress, and 
himself much mortification and blame. 

Although the subject ot perineal fistula, and what is 
called infiltration of urine — that is, when there is an 
opening only into the urethra, letting the urine escape 
into the surrounding tissues, under the skin — is too ex- 
tensive to be minutely noticed here, our object would 
not be attained, without warning the patient of his dan- 
ger, should he be so unfortunate as to fall into incom- 
petent hands. 

Firstly, then, to explain the cause concisely, there 
can be no such thing as an obstruction in the urethra, 
sufficient to stop the passage of urine, for more than a 
couple of days at furthest, without rendering the blad- 
der liable to give way, by inflammation causing its ulcer- 
ation. This may occur in any part of it. If the ob- 
struction exists in the course of the urethra, however 
near, as in Cowper's glands, for instance, scarce an inch 
from the cavity of the bladder, the urine, if it cannot 
pass, even drop by drop, and a catheter cannot be in- 



THIRD STAGE. 107 

traduced, to draw it off by, will force its way through 
the urethra ; or perhaps the little gland itself, as we have 
said, will suppurate and break, thus letting urine out of 
the urethra, into the loose connecting tissues under the 
external skin. If left here, it would cause extensive 
mortification, by its acrid nature. I have seen it left, 
and continue to accumulate, the obstruction remaining, 
from permanent stricture of the urethra, (see that chap- 
ter,) until it caused mortification of the skin all round 
the private parts, completely denuding the testicles. It 
should be freely opened, and as soon as possible a 
catheter, or flexible India-rubber tube, introduced into 
the urethra, through which the urine must pass whilst 
the fistula heals up. Yet this is a tedious affair, and it 
is often a long while before any kind of catheter will be 
borne, the urethra being so irritable and inflamed. 

It is the duty of the surgeon, if he cannot, by judi- 
cious treatment, or an operation upon the stricture, ob- 
tain a passage for the urine, and cannot pass the small- 
est gum elastic catheter, not to let his patient run the 
imminent danger to life incurred, by a rupture of the 
bladder, but rather to puncture this viscus through the 
rectum. This is not to be done until bleeding by the 
irm, leeches, the warm bath, copious doses of lauda- 
num, the muriated tincture of iron, and clysters of lau- 
danum have been tried, the choice of the remedies de- 
pending upon the nature of the obstruction. 

The professional reader will see, that these remedies 
are directed as much against spasmodic as inflamma- 
tory obstruction. Indeed, they always go together, and 
it is on this account that the tobacco enema has been 



108 GONORRHEA. 

recommended by great surgeons. T have a horror of 
this, from having twice witnessed the near approach of 
death from its use, and cannot urge it, if the potent 
remedies, above enumerated, have been faithfully tried. 
I would not use it myself, nor permit it to be used in 
my own case. 

This is a view of the third stage of authors. The 
fourth is naturally connected with it. It maybe known 
by the pain extending over the whole lower part of the 
abdomen, and constant and increased desire to pass 
water and faeces, with great quantities of slimy discharge 
from the bladder. This separates in time from the 
urine, and subsides to the bottom of the vessel. There 
is often intense pain in the end of the penis, and occa- 
sionally in the anus. Most of the treatment applicable 
to the last stage, is equally so to this. Opiate fomenta- 
tions, over the lower part of the abdomen, may be ad- 
ded, and gentle laxatives of castor oil. We have how- 
ever two admirable remedies, from the vegetable world, 
Uva Ursi, and Diosma Crenata. Equal parts of each 
may be infused in hot water, and when cold drunk occa- 
sionally, by the patient, a wine glass full of a strong de- 
coction every hour. This, with laudanum injections by 
the rectum, and profound rest, will soon relieve from the 
more urgent symptoms. 

After a few days' interval, the use of Balsam Copaiba 
may be tried. Yet I need not say so active a remedy, 
under such circumstances, should only be entrusted to 
professional hands. This medicine acts very favourably 
in producing tolerance of its contents by the bladder, 
yet T have observed that wheie the mucous membrane 



THIRD STAGE. 109 

of this organ has been much affected in gonorrhea, a 
long time elapses before the patient feels as he did before 
his attack. He is unable to beai the least excess ; — 
wine, late hours, damp feet, women — all have a very 
bad effect. He must be content to vegetate for a long 
rime, if his attack has been serious, and his habits ir- 
regular. 

I have reserved all mention of the Balsam Copaiba, 
and Cubebs, Cantharides, &c, as they are so various- 
ly applied by physicians, and that too of equal preten- 
tions to practical skill, that it might seem invidious to 
speak with great decision on any one method of using 
them. As a means of controlling the discharge in a 
chronic stage, they are quite indispensable, yet, for my- 
self, I never use them without other local means. 

It is to be regretted that the uncontrollable nature of 
our patients, in this stirring city, is the cause of our hav- 
ing so many cases requiring these remedies. Were it 
possible to subject them to early discipline, very few, I 
am convinced, would require them. 

It sometimes though rarely happens, that an ex- 
cessive flow of blood occurs from the penis, and it has 
been known to continue with such uncontrollable vio- 
lence as to destroy life. An instance lately happened 
to a very careful practitioner in this city, and occurred 
without any assignable cause. Nothing but the intro- 
duction of a catheter, and passing a tight bandage 
around the penis, controlled it. It was necessary to let 
it remain an entire week. Should such an accident 
occur, before resorting to this measure, I would use in- 
jections of alum or gum kino. 
10 



I 10 GONORRHEA. 

There is some difficulty in detecting the presence of 
gonorrhea in women, especially if they should be in- 
clined to conceal their symptoms, in consequence of the 
frequent existence of leucorrhea, or the whites, to which 
they arc so subject. If, as in the male, there was but 
one passage, there would be no difficulty, as the ardor 
urina, or scalding, would make it certain. Yet gon- 
orrhea may exist in the vagina alone, where this symp- 
tom cannot occur, and leucorrhea often produces every 
individual symptom of gonorrhea .in this passage. 

Should it attack the urethra, which is very short, it 
soon reaches the bladder, and produces all the usual 
symptoms, as above enumerated, except the urinary fis- 
tula. These do not happen, as there are no obstructions 
from the enlargement of glands, or strictures. There are 
none of them near the bladder, as in men. There are, how- 
ever, small mucous glands around the vagina, and near 
the larger Labis, which close the passage. These may 
suppurate, and they should be early opened, to prevent 
their burrowing extensively, which they are very apt 
to do. 

As all the other treatment applies to females, as well 
as males, it is useless to repeat it. The use of in- 
jections, however, requires distinct notice. It is quite 
useless, nay very wrong, to attempt to instruct a female 
patient in the use of a syringe, for the urethra. The 
passage is so short, that if the radical cure should be at- 
tempted, the injection is dangerous, in careless hands, 
for it may pass into the bladder, and produce excessive 
irritation, causing perhaps actual inflammation. Al- 
though disagreeable, I fear the practical surgeon must 



THIRD STAGE. Ill 

submit to the duty himself. This is excessively trouble, 
some, yet. it is quite unavoidable. A female will use the 
ordinary syringe, adapted to the vagina, very well. 
They should always be made of glass, as many of the 
substances used as injections, act chemically upon me- 
tallic ones. 

There is one symptom that is laid down in medico- 
legal authors, by which we may distinguish gonorrhea 
from leucorrhea. The discharge from the former stains 
the linen of a greenish hue, — that from the latter is 
merely albuminous. There is also much more heat 
about the parts in the former, than in the latter. 

I take occasion here to remark, that in consequence 
of my attachment to the radical cure, I have not no- 
ticed until now, the method recommended by some em- 
inent surgeons, of using injections much milder in char- 
acter, than those I have recommended. There is no 
doubt whatever, that their known inefficacy depends 
principally upon the infrequency of their use, and their 
weakness, and that they should be much oftener used, 
if designed to have any other effect than irritating the 
parts, and injuring the patient's prospects of cure. 
These sentiments are now held by many judicious prac- 
titioners. 

Balsam Copaiba, notwithstanding the elegant form 
in which it is got up, in capsules, &c, is a remedy very 
apt to disagree with the stomach, and so long as there 
is a choice, I prefer relying upon decisive injections. 
The popular idea that they produce strictures, origina- 
ted in medical ignorance and indolence. It is, as all 
pathologists well know, the long continuance of inflam- 



112 WARTS ON THE GLANS. 

mation that produces them. In the article on stricture» 
I shall fully explain the theory of their formation. 

Warts on the glans. — One of the frequent and 
troublesome consequences of gonorrhea, is the forma- 
tion of groups of warts over the glans, or end of the 
penis. They are often very extensive, completely cov- 
ering the whole glans. They should be snipped off 
with scissors, and their roots touched with caustic. This 
is by far the best way to treat them. Sometimes their 
renewed growth is prevented by touching them with 
strong acetic acid. 



CHAPTER IV. 

GLEET. 

In the preceding article, we have treated of the im- 
mediate consequences of an application of the specific 
poison of gonorrhea. There is a long train of results 
often dependant on this, that involves the happiness of 
the patient to an extent almost as great as in syphilis. 
Indeed, when we take into consideration the importance 
of an assurance of their perfect virility to most men, 
with the greater frequency of these affections, and their 
more direct influence upon the functions of the genital 
organs, there is no doubt that they affect their future 
happiness, if we leave posterity out of the question, to 
a much greater extent than syphilis. 

The jealous care which nature has implanted in the 
breast of every man, for the preservation of his vhulity, 
does not however originate in that instinctive passion, 
that he shares in common with the lowest grade of ani- 
mals, but in that more exalted part of his moral nature, 
the desire to love and to protect some object, physically 
his inferior ; — hence the connexion of sensual passion 
and the sentiment of love. The intimate union of the 
two emotions, with their mutual dependence upon the 
physical integrity of the genital organs, invests this sub- 



114 GLEET. 

ject with a degree of interest that can scarcely be sur- 
passed by any department of medical science. 

If the practical surgeon, whose abilities exist in a re- 
gion more exalted than his fingers' ends, were asked to 
define the cause of the physical and mental inferiority 
of the young men that meet our gaze at every corner 
of the street, he would be obliged to say, if he spoke a 
truth corroborated by his daily experience, that their in- 
tegrity is impaired either by actual disease of structure, 
or unmerciful exaetions upon their nervous systems. 
See chapter on spermatorrhea. 

A correct definition of gleet, involves a matter of 
great importance, upon which the surgeon is constantly 
importuned for information, and which unfortunately he 
may give incorrectly, producing most disastrous results 
to the happiness of the patient. We will explain. 
There are many surgeons who define gleet to be, "the 
discharge that is left after the specific inflammation has 
entirely ceased in gonorrhea." The patient (perhaps 
a married man) is desirous of knowing when his dis- 
ease ceases to be infections ; and here lies his danger. 
Some surgeons observe, that the discharge must be 
colourless, and then it will not infect. Granting this 
were true, and we are by no means convinced of it, we 
know it may be colourless for weeks, and then assume 
a perfectly purulent character, precisely as in the sec- 
ond stage of gonorrhea; and then it may again be, and 
as every surgeon well knows often is, infectious. Now 
who can say at what period ihis may occur 1 

Gleet must exist a long while before all danger of 
infection is past ; how long we cannot say, for we have 



GLEET. 115 

<inown infection communicated in the sixth month. 
Some very distinguished authors deny this ; but we give 
simply the results of our own observation, having been 
severely blamed for being governed by theirs. In one 
instance particularly, our feeble powers of eloquence 
were taxed to the utmost, to restore the domestic hap- 
piness of a very amiable, though foolish man, who ex- 
torted our permission to resume his marital rights, when 
in truth, we ought not to have given it. Suspicion was 
excited in the wife, in this case, by the unwonted absti- 
nence ; — and this will often make patients importunate, 
in order to avoid suspicion. That is his affair, not the 
surgeon's, who is bound to avoid all responsibility in 
these matters. 

Still we have not defined gleet. It is the thin and 
generally colourless discharge, that occurs-some weeks 
*fter the subsidence of all the inflammatory symptoms 
of gonorrhea. 

I have had several cases, analogous to one mentioned 
by Mr. Bell, in young people, who had been affected 
months before marriage, having their worst fears excited, 
a day or two after, by the appearance of a profuse col- 
oured discharge. This however, in all the instances, 
has been unaccompanied with heat or scalding, and has 
subsided upon abstinence. Mr. Bell recommends a 
slight injection. I prefer, however, leaving it to nature, 
as the cause was excitement alone ; it is more rational, 
when that is withdrawn, not to interfere. I mention the 
fact, in order to prevent unreasonable suspicions of the 
chastity of either party. It is always best to discour- 



116 



GLEET. 



age the green eyed monster. He is obtrusive enough, 
to many, without encouragement. 

When treating on stricture, it will be seen that the ef- 
fects of alteration of structure, and gleet, are mutually 
dependent on one another, and, therefore, that the re- 
moval of structural derangement, has much to do with 
the cure. Here it is not our purpose to go into an in- 
terminable discussion, on the subject of active and pas- 
sive discharges. We think we can do much better, than 
to offer any ideas of our own, on this most important 
point, by presenting an analogy, in the treatment of ex- 
ternal or conjunctival inflammation of the eye. 

There is a period, in the decline of inflammation of 
that membrane, when all practitioners ought to recog- 
nize the propriety of using stimulating remedies, ap- 
plied directly to the relaxed vessels of that surface. 
These have the best effect, and the only caution I would 
suggest is, that a sufficient time should be allowed to 
elapse between each application, to observe correctly 
the effect produced, whether good or bad ; for it is by 
no means unlikely, that the practitioner may be com- 
pelled to resort to internal medication. The only way 
is to try, and observe if local means will answer. I 
should always use them ; not only because more imme- 
diately agreeable, but from the fact, that I have seen 
many instances, in which months elapsed, before the 
distressing derangement of the stomach subsided, aftei 
the free use of copaiba and cubebs. 

Gleet also has its stages, that are useful for practical 
purposes. In the first stage, any irregularity of living, 
will produce aggravation of the discharge. It behoves 



117 



the patient to use the greatest care, as he may rest as- 
sured, the longer it lasts, the more difficult it will be to 
cure. From the very nature of the structure, of the 
mucous membrane of the urethra, its extreme delicacy 
and vascularity, this is inevitable ; and it is quite ab- 
surd, for patients to rail at their doctors, when their dis- 
ease may be said to be so unmanageable, as to be con- 
stantly under the influence even of their very thoughts. 
It is on this account, that they should abstract them- 
selves from all lascivious conversation, and prurient ex- 
citement. 

The pure air, and wholesome exercise of carriage 
riding, in the country, will prove very serviceable. The 
patient should never mount a horse, for obvious reasons. 
It is a direct irritant to the genital organs, and will al- 
ways aggravate the symptoms, in the commencement 
of the affection. Costiveness is to be most carefully 
avoided. Should the patient have suffered under the 
second or third stage of gonorrhea, the prostate gland, 
as well as Cowper's glands, may be involved in the dis- 
charge, as well as the mucous membrane of the urethra. 
And as these glands are immediately in the vicinity of 
the rectum, not only the distension of the bowels, with 
hardened faeces, will operate as an irritating cause, but 
the straining at stool, will aggravate directly the disease. 

Such is the anatomical conformation of parts, that 
two immensely powerful agents compress these glands, 
as well as all the urinary appendages, within the lower 
part of the body, whenever the patient is at stool, and 
the less effort he makes, the less pressure they sustain. 
The professional reader will see that we mean the ab- 



118 GLEET. 

dominal and lavator am" muscles. There is no remedy 
equal to a little good Turkey rhubarb. Any other is 
worthless. The patient should keep it in his pocket, 
and bite off a piece, half the size of a pea, twice a day. 
Purgative medicines are highly injurious. The rhubarb 
imitates nature only. 

Some patients will persist in swallowing medicine, 
and using injections, constantly. We should never 
yield, in the slightest degree, to their whims. Yet I 
have been surprised, by the patient's curing himself 
with an injection, made against my express orders. It 
is therefore much better for the surgeon to try them oc- 
casionally. He will do less mischief, if any is to follow, 
than the patient, who always overdoes the matter. The 
stronger mercurial solution, is the best remedy, in these 
cases. Any of the usual injections may answer; but 
the surgeon never can tell the actual effect of his trial, 
till several days have elapsed. It often does great ap- 
parent harm in the beginning, and at the end of the 
week the patient is cured. 

It will by no means answer, as in the radical cure of 
gonorrhea, to use these remedies of a powerful strength. 
They must be prepared with great care, and of the min- 
imum strength, because we do not know the actual state 
of susceptibility of the membrane, and if we are to do 
no good, we should, at least, endeavour to avoid injur- 
ing the patient. All the precaution of diatetics should 
be attended to, as in gonorrhea, only the same rigid ab- 
stinence is unnecessary, in food, though it is especially 
so in stimulating drinks. 

The food may consist of a moderate amount of ani- 



GLEET. H'J 

wial matter, avoiding fat, and gravies, which are power- 
ful stimulants. Vegetables are useful for the bowels. 
No spices whatever ; nor would I advise salt food, as that 
stimulates thirst. The writer confesses complete heter- 
odoxy, on the subject of demulcent drinks, in all ordi- 
nary cases, and candidly beiieves, tne less we drink, at 
all times, the better ; but especially so, when the organs 
for the reception and voiding of urine aie deranged. We 
seek rest for them, and I must confess, drinking always 
seemed an odd way to attain it. 



CHAPTER V. 



SECOND STAGE 



Inasmuch as 1 believe the third stage of gleet to be 
intimately connected with permanent stricture of the 
urethra, I shall consider it as belonging to the chapteT 
on that subject. The only benefit to be derived from 
the division of this disease into stages, is its practical 
application ; and this, I conceive, to be very important 
here. No person accustomed to treat these cases, if he 
enjoys any higher range of observation, than what ap- 
pertains to physical facts, and the mere mechanical 
treatment of disease, can fail to observe the effect of an 
obstinate gleet upon the mind of his patient, and to con- 
nect this with its operation upon the disease itself. 

If the patient be nervous and imaginative, and above 
all, if he cannot control the many annoying circum- 
stances which often influence imprudent people, the 
physician may congratulate him upon his speedy cure, 
on one day, and on the next, without any other irregu- 
larity, than some unpleasant intelligence, find him in a 
state of actual despair, and his symptoms greatly ag- 
gravated. This is one evil. A very delicate and san- 
guineous patient, is so liable to impression upon the 
slightest change of diet, and boarding is so common, 
that it is almost impossible to control that ; and in our 



SECOND STAGE. 121 

climate, during two thirds of the year, the regulation of 
clothing is equally impossible, at least with the amount 
of forethought those who get gonorrhea, usually pos- 
sess. Thus it is, that a variety of causes conspire to 
introduce the patient into a period of the disease, in 
which, from its long continuance, the powers of body 
and mind reciprocally act upon one another, and so far 
enervate the system, as to demand constitutional treat- 
ment and tonics. This is what I mean by the second 
stage. 

So far as medicine can exert an influence upon such 
a case, I know of nothing that equals the syrup of the 
Iodide of Iron. Twenty drops of this beautiful prepa- 
ration, thrice a day, in a wine glass of sugar and water, 
will produce extraordinary tonic effects ; and if it is 
possible to add to it the restorative influence of agreea- 
ble society, and good air, with a well chosen diet, the 
patient will soon be brought up to an ordinary standard 
of health. Yet there still remains the discharge ; and 
as this is local in character, many suppose that it can 
only be removed by local remedies ; others, that noth- 
ing but natural causes can effect it. In truth, there is 
no doubt that nature is best competent to the removal 
of every abnormal state, were it possible to submit en- 
tirely to her laws. But as this is impossible, and art 
can only be resorted to with propriety, when it is known 
to be in direct harmony with nature, we must endeav- 
our to imitate her, as closely as our limited perception 
will admit. 

There is supposed to be this difference, between the 
condition of parts in pure gleet, and in stricture, which 
11 



122 GLEET. 

is usually accompanied with gleet. In gleet, the part 
of the mucous membrane, where it exists, is supposed 
to be merely gorged with blood, and puffy or relaxed in 
its condition. In stricture, either the mucous mem- 
brane, or the parts directly beneath it, are permanently 
thickened or enlarged, by a substance actually produced 
by the inflammation. Therefore it will be seen, could 
the puffy condition of the parts resume its tone, the dis- 
charge would cease, for the puffiness is only a condition 
of the blood vessels, in which they throw out, or pro- 
duce, the mucus. 

Stimulation may compel these vessels to subside. 
The injections were used for that purpose, and if they 
have failed, we are obliged to resort to other means. 
The remedy to which I attach the most consequence, 
La this advanced stage, is the introduction of bougies. 
It will be understood by the reader, not because he has 
stricture, but for fear he may have one. The mechan- 
ical presence of the bougie, is sometimes very effica- 
cious in altering the action of the blood vessels, and thus 
stopping the production of the mucus. After a daily 
trial of this, for a few days, cubebs may be used simul- 
taneously, a tea-spoonful, in any convenient vehicle. 
If this should be efficacious, it must be continued occa- 
sionally, for a day or two at a time, for weeks together, 
as the discharge is apt to return. 

During this late period, the patient may use mode- 
rately wine, or malt liquor, if accustomed to it; and 
observing the effect, continue it, if not injurious. Some- 
times it actually benefits as much in this stage, as it in* 
jures him in the previous one. 



SECOND STAGE. 123 

If, after a few more weeks, the disease still persists, 
a very careful examination must be made of the pros- 
tate gland ; a bougie, of the full size, must be intro- 
duced into the urethra, and then the finger being passed 
into the rectum, the surgeon will be able to form a more 
correct judgment of its actual state. I make the sug- 
gestion of this mode of examination here, because the 
books give no such directions in gleet, and I know its 
value from experience. Whether disease be found or 
not, in addition to the means usually adopted in that 
event, I have always found the best results from direct- 
ing the patient to the sea-side. Mr. Hunter remarked, 
that more patients were cured by sea bathing, than any 
other means, and actually directed injections of sea 
water, supposing that the iodine, in solution therewith, 
benefited a possible scrofulous state of the gland. 

Although, in the treatment of gleet, cubebs has effect- 
ed the most benefit of any internal means, I have used 
copaiba, cantharides, and turpentine, with occasional 
relief. In this stage, an issue in the permseum has 
likewise relieved, and the mechanical action of riding 
on horseback, which we know greatly aggravates the 
disease in its first stage, has cured it effectually ; yet 
it is much to be regretted, that gleet so often passes 
into the third stage, or that of stricture, in spite 
of every remedy that is applied. When this occurs, 
there is but one remedy, and that is the bougie. On 
this there is no room for difference of opinion, although 
the manner of using it is not so well settled. 

The subject of seminal weakness and impotence, is 
one that may be thought naturally connected with gleet, 



124 GLEET. 

but as I conceive that to be produced by venereal ex- 
cess, or masturbation, and that gleet is the immediate 
cause of stricture, I shall rather proceed to that subject, 
and leave those for future consideration. 



CHAPTER VI. 

STRICTURES OP THE URETHRA. 

In those who have had ohstinate attacks of gon- 
orrhea, stricture is a very common consequence ; and 
inasmuch as gleet is the result of gonorrhea, and only 
occurs in cases that have proved unmanageable, it al- 
most invariably may be taken as a symptom of stricture. 

The importance of a correct definition of stricture, 
will be very apparent when we speak of the treatment; 
for it will then be seen, that it must vary with the na- 
ture of the obstruction, and can only be pursued with- 
out great injury to the patient, when its nature is clear- 
ly understood. If we have cause to lament the exis- 
tence of quackery, and its deplorable results, in other 
affections of the genital organs, our regrets are, if pos- 
sible more frequently elicited here, where the ill effects 
of rude and ignorant mechanical interference, often 
produces results that no skill or gentleness can over- 
come. 

A single instance will suffice, to show the danger of 
submitting to irregular practice in these affections ; and 
although it was the result of inebriety in the operator, 
we hope it will prove a caution to some in avoiding 
similar practices ; for the individual who performed the 
11* 



126 STRICTURES OF THE URETHRA. 

act, is an empyric of extensive practice, particularly in 
strictures, in this city. 

A young man, who was supposed to have stricture, 
laboured under the natural deformity of phymosis ; a 
state of things, in which the foreskin is so formed by 
nature, that it is nearly closed, and cannot be drawn 
back, so as to expose the glans, or end of the penis. In 
such cases, this of course requires to be slit up ; see 
chap, on phymosis. The quack, instead of inserting 
the knife under the membrane, actually put it into the 
urethra, and opened that passage full two inches ! The 
writer was called in, by an eminent physician of this 
city, to operate for the closure of the part. It was for- 
tunate indeed, that he chanced to direct the incision 
downwards, as he might otherwise have opened the 
body of the penis. 

The size of the urethra, in the male, has of course 
no definite proportions, varying from eight to ten inches 
in length, according to its distension, and still more so 
in its lateral dimensions ; its sides lying in contact, 
when not distended with urine, or when the penis is not 
erect. A bougie, of a quarter of an inch in diameter, 
may be passed in some individuals, and others, even in 
a healthy state, will not admit one more than the eighth 
of an inch. 

Although there have been disputes about its muscu- 
larity, there can be no doubt of it, in the mind of any 
one who has been accustomed to pass the bougie. In- 
deed, an important division of stricture, is made upon 
the certainty of its mucularity, viz. the spasmodic. It 
is lined with a delicate membrane, similar to the mouth 



STRICTURES OF THE URETHRA. 127 

and lips, and is surrounded, between this membrane 
and the external skin, with a highly distensible tissue, 
that can, like the body of the penis, be filled with blood 
during erection. This makes great care necessary, to 
avoid' wounding the membrane, in passing instruments 

The reader is already familiar with those causes that 
may produce a narrowing of the urethra, by encroaching 
on its calibre, and compressing its sides, viz. the en- 
largement of the prostate gland, Cowper's glands, &c, 
occurring in gonorrhea ; and although there are other 
causes, such as wounds, tumors, calculous concretions, 
&c, that may obstruct the passage, and render surgical 
interference necessary, we mean to confine our attention 
to those which come under the following definition, and 
originate principally from gonorrhea. 

Mr. Wilson, a distinguished British author, gives the 
following : — " A stricture of the urethra, consists of some 
morbid alteration of action, or structure, by which a part 
of the canal is rendered narrower than the rest." This 
is a very complete and philosophical definition, because 
the expression " alteration of action," will give any in- 
telligent reader, in connexion with the following explana- 
tion of spasmodic stricture, a comprehensive idea of a 
surgeon's meaning, when he speaks of "a mere altera- 
tion of action," as contra-distinguished from "an altera- 
tion of structure," which is the second great division of 
stricture. 

A spasmodic stricture, is a contraction of a small por- 
tion of the muscular fibres, whilst the others remain re- 
laxed, often opposing the entrance of a bougie, for a 



128 STRICTURES OF THE URETHRA. 

short time, and then suddenly allowing it to pass. See 
Cooper. 

A permanent stricture, is a contraction of the canal 
from the effusion ofcoagulable lymph between the mus- 
cular fibres, outside of the mucous or lining membrane 
. the urethra, as well as upon and within this mem- 
brane, diminishing the passage for the urine, or com 
pletely closing it up. — Sir Everaid Home, Phil. Trans 
1820. 

Although these may exist separately, as we shall soon 
see, we take occasion to remark, that there can, in our 
opinion, be no case of permanent stricture, without 
more or less combination with spasm. And this we 
would urge as a reason for the exercise of the greatest 
steadiness and gentleness, in passing the bougie. In 
no case, and under no circumstances, should the mere 
mechanical passage of a bougie, give the patient actu- 
al pain ; and that man is doing his patient injury, in 
whose manipulations this occurrence is more than a 
very infrequent consequence. 

We have said that gleet is almost invariably a symp- 
tom of gonorrhea ; and although ample experience has 
verified this in our own practice, we prefer quoting two 
of the most distinguished European authors, rather 
than ofTer our own knowledge on the subject. Our rea- 
sons may not be obvious. We design this book as an 
aid to the practitioner, as well as a warning to the pa- 
tient. 

It often happens, upon a serious announcement of the 
actual extent of his evils, and the necessary means for 
their removal, the patient, who has always a desire to 



STRICTURES OF THE URETHRA. 129 

be cured by medical means, immediately calls to mind 
the assurances of quackery. He has no notion of struc- 
tural derangement producing gleet, and upon the bare 
mention of a bougie — the mildest and only means of 
cure — hastens at once to the quack ; and when he dis- 
covers his error, his difficulties have greatly increased, 
rendering, perhaps, measures of a more complicated na- 
ture absolutely unavoidable. 

John Hunter remarks : — " The spasmodic, and more 
especially the permanent stricture, are generally attend- 
ed with gleet. The latter complaint is often suspected 
to be the only one, until all efforts to procure a cure are 
found to be useless." 

Benjamin Bell, p. 147. — " It is somewhat remarka- 
ble that the formation of strictures is often so gradual, 
that a patient is not sensible of their taking place, till 
the disease has been of long continuance. Being sel- 
dom attended with pain, till the flow of urine is much 
impeded, any partial degree of it passes without notice, 
by which they are apt to be rendered much more fixed 
and permanent, than they otherwise would be. The 
patient, indeed, has seldom any suspicions of strictures, 
till the surgeon, for his own satisfaction, where gleet 
continues for a long time, proposes to introduce a bou- 
gie. Gonorrhea having given rise to gleet, any diffi- 
culty that occurs to the passage of urine, is considered 
to arise from the same cause ; and thus a great length 
of time often elapses, before any such examination is 
made as can, with any certainty, lead to a discovery. 
This proves often, in its consequences, highly distress- 
ing, and ought therefore to be as much as possible 



130 STRICTURES OF THE URETHRA. 

guarded against ; for strictures, by long continuance, 
become much more firm, as well as more extensive, 
than they were at first, by which they become much 
more difficult to cure. Cases, which at first would 
have yielded to the first attempt with bougies, are, by 
delay, often rendered so obstinate, that nothing will re- 
lieve them, but the most exact application of bougies, 
continued for a long time." 

Sir Astley Cooper remarks: — " The earliest symptom 
of stricture, is the retention of a few drops of urine in 
the urethra, after the patient has made water, which 
drops soon escape and wet the linen." — " The next 
thing noticed, is an irritable state of the bladder, evinced 
by the patient not being able to sleep as long as usual, 
without discharging the urine." — "As the disease in- 
creases, the stream of urine is forked, spiral, or scat- 
tered ; and in a more advanced stage, the water is often 
voided only by drops, especially when the urethra is 
under the irritation of cold, or intemperance." In 
these cases, Sir Astley advises the introduction of a 
bougie ; and if one of a common size can be passed, 
the difficulty depends upon enlargement of the prostate 
gland, as tli is would, from its distensible nature, admit 
its passage, but, from its increased general enlargement, 
prevent the stream of urine, by any ordinary effort of 
the contraction of the bladder. 

In addition to these symptoms, the patient will ob- 
serve an immediate effect, particularly after drinking 
liquor, or leaving a warm room, and going into the cold 
air. There will be a difficulty, more than ordinary, 
and often for a short time, a complete inability to pass 



STRICTURES OF THE URETHRA. 131 

wakr. On returning into a warm atmosphere, he will 
be able to urinate. 

Nocturnal emissions of semen, are a very frequent 
symptom of stricture. Nothing also is more common, 
than for a strictured patient, shortly after coition, to 
have a discharge of matter from the urethra. This is 
often supposed to be an attack of gonorrhea, and is 
treated accordingly, the patient congratulating himself 
upon a speedy cure. Upon the frequent recurrence of 
this, he, perhaps suspecting the cause, and receiving a 
more minute examination, learns the nature of his af- 
fliction. I have known actual suspicions of a wife's 
chastity, thus excited, in a newly married and rakish 
husband. 

The reason why those who have strictures, are una- 
ble to retain their urine as long as healthy persons do, 
is this : — In consequence of the stricture, and the diffi- 
culty of urinating, the patient defers it as long as pos- 
sible, and thus the bladder, being constantly kept upon 
the stretch, its muscular fibres lose their patience, as it 
were, and become irritable. This will gradually pro- 
duce thickening of the bladder, and if the stricture is 
permitted to remain, serious and fatal disease may ensue. 

The writer has a patient, now under care, in whose 
case this has occurred. The strictures are so numer- 
ous and complicated, that it is doubtful if they can be 
dilated before death occurs, from irritive fever, and gen- 
eral exhaustion. This person has, for so long a period, 
retained the contents of his-bladder, until compelled to 
urinate, that the urine has been absorbed continually, 
and thrown off by the skin. It is quite unpleasant to 



'1)2 STRICTURES OF THE URETHRA. 

sit in a close room with him, in consequence of the 
strong smell of urine, constantly escaping from his en- 
tire surface, whilst the disease of the bladder and pros- 
tate gland, causes a constant discharge of pus and mu- 
cus, which escapes, drop by drop, from the urethra. 

Should no effort be made to overcome a stricture, and 
it becomes quite impervious to the passage of urine, either 
ulceration of the bladder, or of the urethra, between 
the stricture and it, must occur. If the former, almost 
inevitable death ; and in the latter, as in the ulceration 
of Cowper's glands, an opening through the skin, or a 
permanent fistula will occur. The latter, with any one 
who has much pride of character, is about equal to death, 
and more than one case of suicide has occurred in this 
city, from that cause. 

Disease of the kidneys will often exist, in a greater or 
less degree, from stricture. They become oppressed 
with urine, which it is their office to produce, not to re- 
tain. Ulceration and death is not uncommon from this 
cause. Occasional, sudden and violent attacks of fe- 
ver, with an intensely cold stage, followed by one of 
equal heat, may occur. 

There is nothing to prevent the existence of many 
strictures, though there are rarely more than three, and 
these are apt to occupy definite positions, in their distri- 
bution in the urethra. The most frequent position, is 
the one nearest the bladder, averaging from six and a 
half to seven inches, from the end of the penis. These, 
and if we consider diseased prostate a stricture, which 
it is, so far as the effects are concerned, are the most 
difficult to cure. The next position is about three and 



STRICTURES OF THE URETHRA. 133 

a half inches from the glans, or end of the penis, and 
the third, is often within an inch of the opening of the 
urethra. 1 doubt whether there is any definite order in 
the comparative frequency of these two. The first men- 
tioned, or deepest situated, usually exists, whether the 
others do or not. The two latter often exist together. 

Those which originate from wounds, and other 
causes than gonorrhea, and enlargement of the prostate, 
have no definite position. They are, comparatively, 
very rare, and the rules that concern their treatment, 
do not differ from others. 

We have left the systematic enumeration of the symp- 
toms of spasmodic stricture, till the last, because when 
not combined with permanent, it is the most infrequent. 
It is often called irritable urethra, because there is no 
definite part for its attack. It depends upon general 
irritation of the mucous membrane, — and as that is the 
condition preceding inflammation, and the most effi- 
cient treatment, is such as we adopt for that state, the 
symptoms will be found analogous to ordinary inflam- 
mation of that membrane, — or, that which is not spe- 
cific in character, viz. general uneasiness over the whole 
extent, with more or less pain in passing water, and 
sudden spasms, particularly on going into the cold, from 
a warm room. In this respect, it is like permanent 
stricture. The urine differs in its stimulating property, 
and often, upon any unusual change of living, it will 
become excessively painful, and produce violent spasm, 
and temporary stoppage. The passage of an instru- 
ment causes instant spasm, and its progress is arrested, 
for a greater or less length of time. 



134 STRICTURES OF THE URETHRA. 

I conceive it to be so well settled, that gonorrhea is 
the great cause of stricture, that I shall assume it to be 
admitted, and again quote Mr. Bell, because his author 
ity is sufficient to overthrow all the cavils of the inex 
perienced, on the absurd idea of injections causing 
stricture. There is one reason however, that reduces 
this notion absolutely to an absurdity, and that is, that 
the most frequent position of stricture, viz. nearest the 
bladder, is where the injection never reaches. More- 
over, would it not be infinitely more likely to produce 
it in that part where it most readily finds access, viz. 
the middle of the urethra 1 

In the following passage, a good idea of the manner 
of their formation, is given. Mr. Bell says: " Instead 
of injections being a frequent cause of stricture, I have 
much reason to think they are more effectual than any 
other means of preventing them. Although I have ad- 
mitted that strictures are sometimes produeed by severe 
degrees of inflammation, I do not consider that as a fre- 
quent occurrence. Strictures, I conceive to be, most 
frequently, the consequence of a state directly the re- 
verse of inflammation. In a great porportion of cases, 
they will be found to take place, where, either from nc 
injection being used, or from some other cause, the dis- 
charge has gone on to a very unusual extent, where all 
symptoms of inflammation were gone long before, and 
where nothing but a gleet remained. At least this has 
bed*] the result of my observation, and I believe it will 
be admitted by all who have paid attention to the point 
n question. 

14 1 therefore conclude from this, as well as from ap- 
12 



STRICTURES OF THE URETHRA. 135 

pearances which these parts exhibit on dissection, that 
this variety of obstruction depends upon a state of mor- 
bid relaxation, or debility, induced in these parts of the 
membrane of the urethra, upon which the inflamma- 
tion at first fixes with most violence, and from which 
the subsequent discharge is, in a great measure, pro- 
duced." 

The whole treatment of every mucous membrane in 
the body, whether that of nose, eye, or mouth, corrobo- 
rates this idea. In all these cavities, we recognize pre- 
cisely the state Mr. Bell describes, and in their passive 
stage treat them with powerful stimuli — even with pure 
caustic. 

The writer, and one, at least, of his friends, univer- 
sally admitted to be one of the best practitioners of 
this city, treat leucorrhea by the speculum, and pure 
nitrate of silver, with certain success. And this is a 
perfect analogy Leucorrhea would often assuredly be 
stricture of the vagina, if the passage were narrow 
enough to render this possible, and the principal use 
made of it had not a preventive effect. No doubt 
we could apply nitrate of silver, with benefit, in bron- 
chitis, as in pharyngitis, could we get at the lungs to 
do it. 

So far as the analogy of general treatment goes, 
stimulation, or nutrition, is the best means of cure." 
At any rate, the Sangrado practice of bleeding, purg- 
ing and starving, that has filled the grave with thousands, 
is now done away with, unless in the hands of a few 
practitioners of the last century. 



CHAPTER VII. 



CURE OF STRICTURE 



Inasmuch as strictures present, from their different de- 
grees of density and extent, varied amounts of resis- 
tance, it follows, that agents, corresponding in power, 
must be used for their removal. Some strictures are so 
slight, that they may be represented, in extent and re- 
sistance, to the bougie, by a piece of thread, passed 
round the urethra. These are not common, as patients 
rarely apply, till they may be compared, in extent, to a 
piece of narrow tape. And again, there may be a 
combination of both these, or a whole inch, or more, in 
extent, of the urethra, may be implicated in the nar- 
rowing of the passage, to a greater or less degree. 
Rare and incurable cases exist, in which, from entire 
neglect and inflammation, the whole urethra is closed. 
Of course, in these cases, there is an opening and fistu- 
la, near the bladder, produced by ulceration. 

There are three means of cure, occupying the order 
in which they are enumerated, as to the propriety of 
their choice, though this depends, in some degree, upon 
the nature of the obstacles to be overcome; 1st, dilat- 
ing the stricture by bougies ; 2d, the application of 
caustic ; 3rd, incising the stricture with a small lance, 
concealed in a catheter or tube, or cutting down from 



CURE OF STRICTURES. 137 

the skin upon the stricture, and then passing a catheter 
for the urine to run off by, and allowing the part to heal 
up over it. 

The first, is the method adopted by careful and per- 
severing surgeons, whenever possible. It is destitute of 
pain, or danger, and will overcome all but the worst 
cases of stricture, if faithfully and methodically applied, 
to a patient having sense enough to do as he is di- 
rected. 

The second, with the beautiful improvements of the 
instruments used in its application, is also a safe, and 
not a painful method, in very careful hands. It is adapt- 
ed to those cases which resist the former method of 
treatment. The caustic acting as a destructive agent 
to a very limited extent, if at all; the smallest piece, 
not larger than a pin's head in size, being used. This 
agent, moreover, must take the place of the third, when 
the first is impracticable. 

The third, or incisions by either process, is only to be 
used in desperate cases, although, in the hands of a 
skilful surgeon, it is not a desperate remedy, by any 
means. Of course every patient would choose this re- 
course, rather than submit to the only other alternative, 
ulceration of the bladder itself, or a permanent open- 
ing between the stricture and the bladder, or a fistula, 
made by the surgeon. Of the two methods last enu- 
merated, the incision by the concealed lancet, is by far 
the most desirable ; yet this is only applicable to the 
least extensive strictures, of the worst class. The worst 
always demanding the incision from without, or through 
the skin. 

12* 



(38 CURE OF STRICTURES. 

There is no such thing as treating a querulous and 
discontented person for stricture, with any advantage ; 
and the surgeon who will consent to do so, is more re 
gardless of his reputation than the writer. The men 
tal depression of the patient, in all these cases, is almos* 
incredible ; and the humane surgeon will always give 
his patient every possible assurance of comfort. But it 
should be remembered by the patient, that it requires 
some slight application, and a few years of study, to un- 
derstand the detail of a matter, that may all seem very- 
simple to him ; and he may think unreasonable diatetic 
regulations are enjoined ; but let him remember it is a 
mutual and honourable contract between them — the 
surgeon and the patient. The reputation of the former, 
and the happiness of the latter, is at stake. The sur- 
geon is to do his duty, the patient is to obey, or it is the 
surgeon's duty to leave him. He has no right to risk 
his own reputation or the patient's cure. 

Bougies are now made either of linen or catgut, coat- 
ed with India rubber, or of a very flexible metallic com- 
position, perfectly smooth, and the ends evenly rounded 
— not pointed. The linen ones are now most beauti- 
fully made in Paris. We prefer them much to all oth- 
ers. They taper so perfectly and gradually, that a 
point for the smallest stricture, receives adequate sup- 
port, whilst the necessary gentle pressure is made, to 
cause its entrance into the stricture. Previous to their 
use, the metallic bougie had to be used for all small 
strictures, the finest linen English ones curling up 
in the urethra, upon the slightest pressure. They were 
good for nothing. 



CURE OF STRICTURES. 139 

The non-professional reader may imagine that the 
bougie acts upon mechanical principles, dilating the 
stricture like a wedge. This is even asserted by very 
high British authority ; see Cooper. But we think the 
idea of dilating living animal fibre, absurd. The bou- 
gie could effect no benefit, if it dilated only. The part 
would, immediately it was withdrawn, approximate as 
before. It operates like all other pressure, by producing 
absorption. 

If the smallest bougie can be made to enter a stric- 
ture, and the surgeon and patient will persevere, the 
cure can be effected by that method. It often happens 
that spasm occurs instantly upon the introduction of a 
bougie. Steady and gentle pressure will always over- 
come it. 

The greatest care should be used in the selection of 
bougies without flaw in any part, but particularly near 
the point, as they might otherwise break off, and thus 
enter the bladder. In such an event, (and it has hap- 
pened in this city,) the operation of opening the blad- 
der, or lithotomy, would have to be performed, as a 
stone would soon form round the piece of bougie, or its 
presence cause inflammation of the bladder and death. 

In passing the bougie, after the surgeon has used gen- 
tle and continued pressure, for a minute or two, he 
should withdraw his hand suddenly, suffering the bou- 
gie to remain, but holding the penis gently grasped in 
the other hand. If the bougie recoil, it has not entered 
the stricture, but doubled upon its point, and on with- 
drawing it, he will find it bent. Should it not recoil, 
and resist gentle traction, it has entered. 



110 CURE OF STRICTURES. 

The surgeon is not to expect, when he first passes a 
bougie, with a well tapered point, that when it passes, 
should it do so, (and this is by no means certain, even 
in small strictures,) completely through the obstruction, 
that he will feel it pass through. This he cannot do, 
for it is a wedge. But after he has used several sizes 
larger than the one he began with, — and this will take 
several sittings, — he can then try a round pointed one, 
of suitable size, and it will often go through with a jerk, 
and thus he can judge of the extent of the stricture. 

When the patient is used to the bougie, for it often 
produces faintness at first, the surgeon may introduce, 
as was the practice of Sir Astley Cooper, two sizes at 
a silting. The time a bougie is to be permitted to re- 
main in the urethra, is to be judged of entirely by the 
feelings of the patient ; much pain should never occur 
At first, only a minute or two each time ; gradually 
longer, till ten or fifteen minutes elapse. Patients differ 
very much in their capacity to endure them. After a 
few weeks, they may bear them for hours, and even all 
night. It is often convenient to introduce them on re- 
tiring, in order to save time, as well as irritation, when 
it is necessary they should remain a long time. 

The increase in size is to be governed entirely by the 
density of the stricture. If firm it will necessarily be 
slow ; if otherwise more rapid. As soon as the sur- 
geon judges that the full size of the urethra is attained, 
and he can pass the instrument with facility, he may 
entrust it to the patient himself, who had better use it 
for a quarter of an hour at least, every night for a 
month, then twice weekly, and so on, for a few weeks 



CURE OF STRICTURES. 141 

Here the surgeon's duty ends ; for it is not to be de- 
nied that the stricture has a tendency to. return ; and 
the patient can keep himself clear, by its occasional 
use, as well as the surgeon. After a year or two, how- 
ever, it often happens, if patients live regularly, it dis- 
appears entirely. 

Cure of Strictures by Caustic — When, from 
the extent, or density of a stricture, it becomes impossi- 
ble to pass a bougie, either caustic must be applied, or 
it must be pierced with a stilet, or lancet, as hereafter 
to be noticed. Although we have advised the use of 
the bougie alone, when that would suffice, we have 
stated that strictures, thus treated, are apt to return. 

In 1752, the great John Hunter, of London, first ap* 
plied caustic to a stricture, in a very impracticable case. 
After three applications, he observed that the man 
" voided his urine much more freely," and on applying 
the caustic the fourth time, the canula, or silver tube, 
through which it was passed, on the end of a small 
bougie, " went through the stricture." 

Sir Everard Home observes, — " Having met with a 
number of facts, from which a general principle appears 
to be established, that the irritable state of a stricture is 
kept up, and even increased, by the use of a bougie, 
but lessened, and entirely destroyed, by the lunar caus- 
tic, I am desirous to recommend the use of the caustic, 
in many cases of irritable stricture, in preference to the 
bougie." Mr. Home goes on to detail a number of 
cases, in which permanent cures were effected, during 



142 CURE OF STRICTURES. 

many years, and speaks very warmlv in favour of the 
method. In short, he adopted it " as a general practice. 1 

There is no doubt that in all difficult cases, and par 
ticularly in irritable strictures, the careful use of the 
caustic, is far preferable to the lancet pointed bougie. 
We have often had occasion to use it, and have never 
met with any ill effect. But we have been exceedingly 
careful, and never apply it oftener than once in three 
days. In cases where the patient has experienced pain 
for several days after the passage of a common bougie, 
and has dreaded its introduction so much, that I feared 
his inability to bear it, I have, unknown to him, used a 
very small piece of caustic, and such has been the re- 
lief afforded, that, after two days, I have introduced the 
bougie entirely without pain, and he has urged me 
again to resume it, on discovering the cause of his ease. 
It is unquestionably an admirable assistant to the bou- 
gie, when not used to the extent, or with the object of 
destroying the stricture. I never use it fortius purpose. 
When the smallest quantity is exceeded, in bad cases, 
it requires great care, though I always prefer it to in- 
cision. 

The necessity of the greatest caution will be appar- 
ent, when we reflect, that the effect of caustic is in a 
great degree indefinite. There is no telling with cer- 
tainty the actual effect it will produce, nor with invari- 
able accuracy, the direction its action will take. Yet I 
think both these results may be calculate d, with far 
more certainty, than they have hitherto been supposed 
capable. The first, however, is always, more or less, 
jnder the control of the cautious practitioner, who is 



CURE OF STRICTURES. 143 

never anxious to do too much at once ; and will s there- 
fore, use the caustic more sparingly, only applying it for 
a short time, and fastening it so firmly in the end of 
the hougie, that it will be impossible to drop out or 
break off. 

In regard to its direction, so as to be applied precise- 
ly to the centre of the stricture, I am satisfied, that if 
the mechanical means were always well chosen, and 
the instrument prepared with rigid and mathematical 
precision, so as to be adapted precisely to the structure 
of the part, there would be no difficulty. But surgeons 
are not all possessed of mechanical skill, and instru- 
ment makers are often both stupid and inattentive. I 
have always been obliged to prepare, with my own 
hands, the instrument I am about to mention, and as it 
is designed for the professional reader, T shall describe 
it with accuracy. He may be more fortunate than I 
have been, and by close personal attention, get an in- 
strument maker to prepare it for him, should he think 
proper to adopt it. 

There is but one way to ensure the bringing of the 
catheter, directly opposite the stricture, so as to have 
its centre, and the centre of the end of the cathe- 
ter, precisely opposite each other. That way, is to 
select as large a catheter as the urethra will admit. 
A small one not only never passes with more ease, but, 
inasmuch as it is not directed by the pressure of the 
urethra, which operates evenly all round, it is apt to de- 
viate by any unconscious movement of the hand of the 
operator, and have its point directed against the urethra 
just on one side of the stricture, or above, or below it. 



144 CURE OF STRICTURES. 

Not so with the larger one, which, directed gently, 
the patient always standing at ease, and never sitting, 
is almost sure to feel no undue influence of the hand. 
When it will pass no further, the surgeon must hold it 
with his thumb and two fingers only against the stric- 
ture, which will now be directly opposite the centre of 
the end of the catheter. Now, as these are commonly 
constructed, the object being to draw off the urine only, 
the bore, or cavity, is made of equal extent up to the 
well rounded end ; and if a small hole were made in one 
thus constructed, there would be great difficulty in pass- 
ing a gum elastic bougie, with the piece of caustic in its 
end, through this hole. It could not be directed to the 
centre, for the same reason a small cathether would not 
reach the centre of the stricture, viz. want of lateral 
support and direction. Let the catheter then be made 
with one inch at the end, to unscrew; — it can be done 
with perfect neatness; — fill this with melted lead, and 
then drill a hole through its centre and end ; with a small 
penknife, make this hole a regular cone, with its apex, 
the opening in the end, and its base, merging into the 
sides of the catheter. Burnish it well inside, and then 
screw it on. 

We think, when the caustic is once passed through a 
catheter thus constructed, the surgeon will never use 
any other. He may rest assured, it can go no where 
but to the very centre of the stricture. I always fasten 
the nitrate in a hole, made with a brad awl, in the end 
of a gum elastic bougie, and then, with a hot wire, melt 
the gum immediately surrounding it, so as to make it 
grip the caustic, which should be an oblong piece, as 



CURE OF STRICTURES. 145 

thick as a large pin head only. No mechanical contriv 
ance will hold the caustic, or suffer it to he passed 
through the catheter, better than this. Its flexibility al- 
lows it easily to take the necessary curve of the cathe- 
ter, without displacing the caustic. 

The great advantage of having one instrument to suit 
every case will be apparent to the reader. Indeed we 
cannot see how the caustic could possibly have been ap- 
plied to the stricture with any certainty, when either the 
bougie alone, or that with the straight canula was used 
In the armed bougie the least excess of pressure must 
have tilted up the point, and thus misdirected the caus- 
tic, and the straight catheter must have been very awk 
ward to apply to the curve of the urethra : it will be re- 
membered the worst strictures and those that oftenest 
require the caustic, are there. 

It is impossible to say how often the caustic should 
be applied, as it depends entirely on the extent of the 
stricture. The interval also will depend upon the sub- 
sequent symptoms. It has been said that it should 
not be again applied till the slough or part that was 
destroyed by the first application, separates, so that 
it may be again applied in a new place, thus producing 
another slough : indeed, this is the idea conveyed in the 
term, " destruction of a stricture " by caustic ; we dis- 
sent in toto from all such practice. 

Let us examine this subject : a little close thinking 
will do such important matters no harm. The mucous 
membrane of the urethra is a very delicate structure, 
and is its only proper sheathing : it is so constituted by 
nature and lubricated with its proper secretions, as to 
13 



146 CUKE OF STRICTURES. 

be quite contented to convey that variable and acrid 
fluid, the urine. Secondly : it is a fact universally 
known, that all cicatrices the result of wounds, but more 
especially of such as are made, whether by heat or other 
chemical agency, have a constant tendency to con- 
tract. This is often observed to a great extent, in burns 
and scalds. 

Now look at the practice: the mucous membrane, if 
a slough is produced, must certainly be destroyed, pre- 
senting in that part a cicatrized surface, unsuited to the 
urine, and by its very nature tending to contract. Thus 
the very thing we are endeavouring to cure, is aided to 
return by the means used to remove it ! This is no 
hair splitting — the writer has been obliged to incise a 
stricture greatly aggravated by this treatment ; frequent 
total suppression was often produced by slight excess in 
urine or wet feet. It was by no means a very bad stric- 
ture at the commencement, but the patient was impor- 
tunate, and it was the first case the gentleman had at- 
tempted : he applied the caustic, as he told the writer, 
" to destroy the stricture." 

The truth is this, that those cases that were cured by 
Mr. Hunter and Sir Everard Home by this method, 
were well explained by the latter. The caustic de- 
stroys the irritability and produces absorption of the 
stricture. It is an admirable remedy, but can only be 
used as an adjunct to the mechanical action of the bou- 
gie, in producing that result. 

The only remaining method for the cure of stricture 
that receives the countenance of intelligent surgeons, is 
that of incision ; the practice of attempting to force an 



•JRE OF STRICTURES. 147 

ordinary metallic bougie through a stricture, though I 
regret to say it has been done by men calling themselves 
surgeons, and moreover has a place in books on stric- 
tures, could surely never have been attempted by any 
one having the least fitness for that office. 

Should it ever be proposed, I can only caution the 
patient immediately to quit such a practitioner : the 
least that he can expect would be a great aggravation 
of the stricture, and probably a permanent false passage 
for the urine, either from the giving way of the urethra 
before the stricture, or the point of the instrument being 
actually thrust through it. It has been also proposed 
to use force enough, and for a sufficient length of time 
at each sitting, to cause ulceration of the stricture; this 
in my opinion is nearly as objectionable ; caustic, if it 
were desirable, and it is by no means to be thus used, 
would effect the same object besides preventing spasm, 
symptoms that the pressure would be sure to excite. 

For reasons nearly similar to those which prevent the 
use of forcible penetration of the stricture, the third 
method or its incision by the concealed lancet, is always 
to be avoided when possible, yet there are cases in which 
it is utterly unavoidable ; they are however exceedingly 
rare, and may never happen to those who are not ex- 
tensively engaged in this kind of practice; it must 
therefore be apparent that they should never be under- 
taken by any, unless they are perfectly familiar with 
the varied amount of resistance offered by a great va- 
riety of strictures : in short, if there is in any department 
of surgery a necessity for the " tactus eruditus," or that 
Kind of skill that can only be had by constant practice 



M 



148 CURE OF STRICTURES. 

in every variety of stricture, it is in these cases. The 
utmost gentleness and steadiness is necessary in all of 
them, but particularly in this, where we are about to 
take so important liberty with a structure of the greatest 
delicacy. 

When in a case of aggravated and long continued 
stricture, that has been becoming progressively worse, 
so that the urine has passed drop by drop for a long 
time, and has often been completely suppressed, a com- 
plete stoppage should occur, which will not yield to the 
best methods always adopted for these cases, (especially 
when combined with inflammation or spasm,) — the 
warm bath, bleeding, leeching, the free use of opium, 
and the muriated tincture of iron, — there is no choice left, 
either the patient or surgeon, but the puncture of the 
bladder, or the stricture. The first would not of course 
be adopted in such a case, for the measure could only 
be temporary, the obstruction in the urethra remaining 
as before ; the patient would then rationally select the 
only chance for a radical cure : he will remember that 
this is a case in which the period when dilatation by 
bougies or caustic could be effected at all, has gone by, 
and the stricture is now so firm, and the bladder so dis- 
tended with urine, that immediate action is necessary. 

There are various instruments in use fortius purpose, 
all of them doubtless in careful hands perfectly effective 
of the end designed, yet the writer must again express 
a decided preference for one that he conceives adapted 
to the structure of the part; the only respect in which 
this instrument differs from the one already described 
for applying the caustic, is in the addition of a triangu- 



CURE OF STRICTURES. 149 

lar piercer, one eighth of an inch in diameter at its base, 
so arranged by means of a button on the end of the wire 
to which it is attached, that projects from the other end 
of the catheter, that it never can be thrust more than 
one third of an inch into a stricture : there is a very 
important object in this, inasmuch as if it were longer, 
there would be more danger of piercing the urethra be- 
yond, after it has penetrated the stricture ; one means 
of preventing this, and it should never be neglected, is to 
cause the patient to endeavour during the puncture, to 
pass his urine, by which effort the part of the urethra 
towards the bladder will be equally distended, so as 
to make it one third of an inch in diameter: at 
least, a space which with due attention in holding the 
penis and catheter perfectly straight, the stilet will be 
sure to enter, after it has pierced the stricture. 

As soon as this is effected, which should be done by 
pushing the button home to the mouth of the catheter at 
once, it must be returned within the catheter, and that 
instrument withdrawn. Then introduce a bougie not 
quite the diameter of the stilet and ascertain if you have 
penetrated through the whole of the stricture : if so, a 
very small catheter may be passed, and the urine drawn 
off; but if it is not perforated, an instrument precise- 
ly like the other, but small enough to enter tke perfora- 
tion already made with its predecessor, must be used : 
great care should be taken, to make the point of the 
catheter enter the puncture before the stilet is again pro- 
jected ; all this I conceive to be necessary to ensure our 
keeping in the centre of the stricture, and avoiding 
piercing the urethra, which we should certainly be far 
13* 



150 CURE OF STRICTURES. 

more likely to do, if the stilet were to be thrust forward 
at once, two-thirds of an inch ; we could not then cal- 
culate with sufficient precision the direction of the 
puncture : again resuming the bougie a size less than 
the last stilet, we are to explore the second puncture; 
and if it is perforated, draw off the water, and then dilate 
the stricture twice a day with bougies, and proceed ex- 
actly as in a common case ; we have need to pass the 
bougie twice daily, for there is a great tendency for this 
recent puncture to heal up. 

Though the patient may be able to pass water with- 
out a catheter, still it may cause him less irritation to 
draw it off twice daily wirli a small one, just before 
passing the bougie. If on a second attempt at puncture, 
it should still be found that the stricture is not entirely 
pierced, the surgeon should examine carefully the 
urethra externally, and if upon investigation it should 
prove likely that more than another third of an inch is 
involved, I conceive it to be the best practice to incise 
the stricture from without, and not to proceed with any 
further attempts at internal puncture, because if we 
should succeed in puncturing the stricture through its 
centre, there would be a great chance if the tendency 
to contract in so large a space, would not overcome our 
efforts to dilate it. 

The external incision is a matter before the surgeon's 
eyes, and he runs no risk of error. In this event the 
catheter must first be passed down to the stricture, and 
the surgeon is there to commence the incision. It is un- 
necessary to give any more minute directions, as it is a 
perfectly plain matter ; the patient is to keep his bed, 






CI RE OF STRICTURES. 151 

lie on his back, and pass his urine through a gum-elastic 
catheter which is to remain in the wound : every thing 
depends upon the perfect quiet and the nice apposition 
of the wound. I always use stitches with a fine cam- 
bric needle, and the finest dentists' silk, and then a few 
short strips of adhesive plaster, going half round the 
penis only ; for if the great dorsal vein should be con- 
stricted, an cedematous state would follow, and more- 
over there might be a tendency to erection, and then 
the effect of a plaster encircling the penis, would be such 
as to require its immediate removal. 

Should the irritation of its presence require the re- 
moval of the catheter before the fourth day, the great- 
est gentleness must be used, and on no account should 
it be done till the fifth, if it can possibly be avoided ; 
and even then it will be necessary to draw off* the water 
for at least ten days or a fortnight, for its pressure in 
passing is considerable, and its acrid nature might also 
seriously irritate the wound. 

Dilatation by the bougie is still more necessary for a 
length of time in these cases than in others, because 
of their greater extent and firmer nature : the pa- 
tient must be content to pass them occasionally for 
years, and then he has cause to be thankful that 
lie has escaped with his life from ulceration of the 
bladder, or at least without a fistula and the loss of his 
virility. 

In the description I have given of the instruments 
used for passing the caustic and incising the stricture, 
I have been sufficiently minute to enable those who 
choose, to adopt a method not only adapted to the struc- 



152 CURE OF STRICTURES. 

ture of the part, but constructed, as I conceive, upon 
principles that ensure the application of the intended 
effort with the most unerring accuracy in skilful hands, 
and without much danger in those that are not so : and 
I hope, inasmuch as it is evident to all, that some of the 
most intellectual men are sadly deficient in manual 
dexterity, though actuated by the sincerest desire to 
benefit their patients, they will adopt the mode, should 
they reject the reasoning for its application. 

The plan of incising a stricture through the skin, 
should never be chosen but in cases that present no 
other chance of relief ; there is no difficulty in its per- 
formance, but much more doubt of its complete success 
than in any of the other methods. It is to be regretted, 
yet truth requires the observation, that bad strictures, 
however skillfully treated and completely relieved, are 
very apt to return, without the constant use of the 
bougie. 

On the subject of strictures in females, there is in 
reality nothing to be said, further than the fact that they 
are exceedingly rare, and when they do occur require 
no other method of treatment than the use of the bougie. 
The urethra is in them so short, that the force with 
which the urine is expelled has no inconsiderable ability 
in dilating the passage: whilst its entire freedom from 
that complicated glandular obstruction that exists in the 
male, and the pressure of the greater mucous surface of 
the vagina, on which gonorrhea usually spends its 
greatest force, directly beneath it, gives it an immunity 
from all the graver symptoms of this disease. 



CHAPTER VIII. 

fistula; or, false passages in the urethra. 

The reader is already aware, that if the stricture 
should not be penetrated in some way, the opening 
must be formed for the urine, either through the walls 
of the bladder itself, or what is fortunately more frequent, 
ill the urethra, near the stricture ; the urine, by its dis- 
sension, causing ulceration of the mucous membrane, 
and escaping into the cellular tissue, a loose substance 
connecting all the different parts of the body together. 
Should it escape from the base of the bladder, it will 
soon be completely diffused in this tissue, which extends 
every where under the skin, and the sooner it is let out, 
by incisions, the better, as there is nothing that so read- 
ily produces mortification, as urine ; the most formida- 
ble abscesses occurring, in consequence of its lodgment 
in any part of the body, but particularly in the loose tis- 
sues near the genital organs. 

Should the ulceration occur in the mucous mem- 
brane of the urethra, the urine may diffuse itself be- 
tween it and the skin, as far as the glans or end of the 
penis, and produce mortification, and perhaps destruc- 
tion of the whole penis. When it occurs far back, near 
the anus, it usually finds its way into the scrotum, and 
in consequence of the extreme looseness of this part, 



154 FISTULiE OF THE URETHRA. 

may distend it. enormously, and produce mortification 
that may completely expose the testicles. A. 11 tins 
would of course be accompanied with great fever, and 
prostration of the vital powers. Of the treatment of this 
state, we are not of course to speak here. It is only 
mentioned, to show the necessity of compliance with 
the measures necessary for its prevention. 

When the urine finds it way through the externa 
skin, in the course of the urethra, the stricture remain- 
ing, it must become a permanent fistula. Should the 
patient submit to an operation for the cure of this, it is, 
in the first place, to be preceded by the operation of 
opening the stricture, and passing a flexible catheter 
into the bladder, which is to remain there for the urine 
to pass off by, the patient lying on his back, until the 
fistulous opening is healed. This is to have its edges 
cleanly excised, and to be approximated in the nicest 
manner, with one or two stitches, going just deep 
enough to leave out the mucous membrane of the ure- 
thra, and no more. The catheter, being first intro- 
duced, will prove an excellent guide for this nice mani- 
pulation. 

This operation, when judiciously done upon a patient 
entirely tractable, will always prove successful. It some- 
times happens, as we have already said, that extensive 
and numerous openings in the skin, or sinuses, are pro- 
duced by ulcerations, proceeding generally from one 
principal one, that communicates with the urethra ; — 
these often occur very near the bladder. They must 
be all completely laid open, to their very beginning in 
the urethra, and filled with lint, so that they will be com- 



FISTULJS OP THE VAGINA. 155 

pelled to heaL from the bottom. A catheter must then 
be introduced, as before. Nothing can ever heal them 
but this. Injections into the sinuses, are not worth a 
trial, for they will surely disappoint both patient and 
surgeon. 

The operations for these sinuses, when neglected, be- 
come very formidable in extent. The most extensive I 
ever witnessed has been already alluded to, when speak- 
ing of affections of the prostate gland in gonorrhea. 

Vaginal Fistula. — There is a fistula, communicating 
with the vagina, in females, caused by the lodgment of 
the child's head in protracted parturition ; its pressure 
against a single point of the urethra, for several hours, 
causing ulceration. This subjects her to the distressing 
inconvenience of the involuntary passing of urine 
through the vagina. An operation is performed for ex- 
cising the edges of the fistula, and then approximating 
them with stitches. It is often unsuccessful, or only 
partially so, from the impossibility of obtaining com- 
plete access to the parts, when operating. In a future 
work, we are now preparing, on female diseases, we 
hope to advance some useful mechanical hints on this 
subject. As strictures of the urethra, in females, are 
very uncommon, so fistulas, from that cause, are almost 
mknown. We have never met with a case, in our own 
practice, or heard of any, in that of our friends. 

There is also a similar fistula, occasionally existing 
oetween the vagina and rectum, in which the fasces 
pass into the vagina. Its cause is often similar o the 
preceding, and its cure equally difficult. 



156 MALFORMATION OF URETHRA. 

Malformation of urethra.— There is a peculiar 
malformation in the meatus, or opening of the urethra, 
from birth, and not in any way connected with stricture, 
yet as it sometimes occurs, and is the subject of great 
annoyance, we will describe it here. 

The opening of the urethra, is greatly contracted in 
size, and instead of appearing in its ordinary position, it 
opens near the end, yet quite under the urethra, so that 
the stream of urine is greatly contracted, and passes di- 
rectly downwards, at right angles with the penis. This 
must impair the virility of the person thus formed ; yet 
not entirely. 

Doctor James E. Smith, of this city, recently request- 
or! me to operate, in a case of this kind. The patient 
was a married man, and the father of two children. He 
was unconscious of any other inconvenience than great 
annoyance in urinating. The operation is one of great 
delicacy, and some uncertainty, as the same liability of 
the new opening to contract exists, as in cases of stric- 
ture. 

The old opening must be healed up, by incising its 
edges by an elliptic incision, circumscribing it entirely, 
and made transversely with the penis. The skin, which 
is very flexible, must then be drawn forward complete- 
ly over this elliptic incision, as far as its anterior edge, 
which is to be made directly under the glans, cutting 
away the frcenum, if necessary. It must here be at- 
tached with several stitches, and a new opening made 
through the lower part of the glans, in the natural situa- 
tion, with a very delicate piercer, with a lancet shaped 
point. 



MALFORMATION OF URETHRA. 157 

I am in the habit of using a similar instrument for 
this purpose, and the operation for lachrymal fistula of 
the eye. It is literally a delicate spear, one inch in 
length, and the eighth of an inch in diameter, at its 
broadest part. This is to be passed through the glans, 
in the ordinary situation of the meatus, in a line with 
the urethra, until it enters its cavity. The end of a 
small bougie, of sufficient length, is then to be intro- 
duced, the rest of it having been cut off". This is to be 
secured by passing a piece of thread, with a needle, 
through its base, and tied round the end of the penis. 
Thus all danger of its entering the bladder is avoided. 
It will have to be worn a long time, and increased in 
size, some two or three times, before it effects its pur- 
pose. But the increase of satisfaction, in performing 
all the functions of the part, usually induces patients to 
submit to the annoyance. 



^HHI 



CHAPTER IX. 

PHIMOSIS AND CIRCUMCISION. 

There are two conditions of the prepuce, or that 
moveable part that can be drawn over the glafls, and re- 
tracted again, that occasions, during syphilis and gon- 
orrhea, the greatest annoyance, and demands the inter- 
ference of the surgeon. The enlightened nations of the 
earth, should surely adopt the ancient rite of circum- 
cision, as admirably adapted, not only to prevent these 
minor evils, but, in all probability, by facilitating clean- 
liness, the existence of the diseases themselves, as well 
as other serious affections of the same parts. ITey, 
Boyer, and Roux, all speak of the intimate connexion 
of phimosis and cancer of the penis. 

The author trusts he will be able to give a perfectly 
intelligible explanation of these affections, without the 
aid of illustrations. They have been purposely avoid- 
ed, throughout the volume, because they are so apt to 
excite prurient ideas, in the young ; a nd the work be- 
ing designed for popular instruction, it is hoped will do 
no harm, if it does no good. Those filthy and obscene 
publications, that come fairly under our sleeping act, for 
the suppression of licentious prints, are a sufficient dis- 
grace to those who write, and those who publish them. 

The foreskin, or prepuce, as it is termed in anatomy 



PHIMOSIS. 159 

is, as every male knows, a prolongation of the skin cov- 
ering the penis. When drawn back, it is seen to be 
united with a far more delicate tissue, that is continued 
over the glans, and actually into the opening of the pe- 
nis ; it there becomes still more delicate, and forms the 
lining of the urethra, and so on to the bladder itself, and 
even the kidneys. 

This is precisely analogous to the skin passing from 
the face, over the lips, into the mouth, stomach and 
lungs. The inner and outer skin, if we may so speak, 
merge imperceptibly into each other. A nd we here 
take occasion to say, that this furnishes a good reason 
to be very careful in avoiding chills, and all exposure 
to the night air, when the mucous membranes of any of 
these cavities are affected with disease. The reader 
will remember the effect of going from a warm room 
into the cold air, in stopping the urine in stricture, and 
the great aggravation of gonorrhea by v/et feet ; and 
we all know the contraction of a common cold, or ca- 
tarrh, by the same cause. 

Whatever has a tendency to inflame and thicken the 
prepuce, will, in proportion to its extent, either prevent 
its retraction, or when retracted over the rim of the 
glans, suffering it, in its thickened and contracted state, 
to fall into the deep groove, which separates the glans 
from the body of the penis, prevent its return. The for- 
mer is called phimosis, from (Jh/xo*, a muzzle or bridle ; 
the latter, paraphimosis, from Ciapa, about, and (fx^oo, to 
bridle. Either of these states may also be produced by 
swelling of the glans itself, although, as they are con- 
tinuous, the prepuce is usually affected equally with it. 



J60 PHIMOSIS. 

Phimosis is also a deformity, with many, from birth 
Indeed, it is those who have naturally too long a fore- 
skin, who are most liable to these accidents. We will 
now describe them in order, beginning with natural 
phimosis, in its greatest degree. 

This, also, often occurs from neglecting to retract it 
in very old men. A young man, aged eighteen, has 
just been dismissed from attendance, cured by the opera- 
tion. It was so complete, in his case, that the opening 
in the prepuce was far less than in the penis, and he 
experienced so much difficulty in passing his water, that 
he supposed himself strictured. This proved to be the 
case also, but it could not be ascertained till the phi- 
mosis was removed. 

The Jews draw the foreskin through an oblong open- 
ing, in a small silver plate, and cut it off obliquely, in 
the direction of the glans. This is protected by the 
plate, which intervenes between it and the knife. This 
operation can only be done in infancy, when the integu- 
men is delicate, and can be easily elongated. 

In my patient, the following operation was perform 
ed : A small grooved instrument, called a director, was 
passed between the glans and prepuce, as far as it would 
go, that is, with no pressure greater than would just 
carry it to its destination. A sharp pointed, curved 
knif •, was passed upon the director, and piercing the 
prepuce, it was severed at once completely through, so 
as to expose the glans. The corners were then remov- 
ed with scissors, and six delicate stitches, made with a 
cambric needle, attached the mucous membrane to the 
outer skin of the remaining prepuce. 



PARAPHIMOSIS. 161 

We are in the habit of using a forceps with its two 
chaps curved, and an inch in length, at right angles 
with its shafts ; these greatly facilitate the operations 
upon this part ; they enable us to grasp the corners, 
and remove them with mathematical certainty at a sin- 
gle clip of the scissors, instead of the repeated and ir- 
regular incisions with the knife ; indeed we have long 
since ceased to use the common forceps for any opera- 
tion where there is much loose skin. These instru- 
ments are described by the writer in the Boston Medi- 
cal and Surgical Journal, and it gives him great plea- 
sure to state, that they have been much approved of by 
the profession. 

This is a fair illustration of the operation for natural 
phimosis; if is often performed by the practical surgeon, 
and is only to be done when the parts are uninflamed, 
and at rest, if the surgeon can have the selection of 
time : yet it often happens that a patient presents him- 
self with chancres concealed by the prepuce whilst in a 
state of inflammation, producing phimosis; or such ir- 
ritation of the glans in gonorrhea, as causes by the 
swelling and inflammation of that part and its continua- 
tion to the prepuce, the same result: now the parts 
being so much inflamed, it would be highly injudicious 
to proceed with the same operation, as they would not 
unite, and a very irregular and unseemly state of the 
prepuce would remain. 

The plan we adopt in such cases is, to make the first 

incision only, thus exposing the glans, which enables us 

to examine and treat the chancres, or the urethra, as 

the case may be. The edges of the wound should be 

14* 



162 PARAPHIMOSIS. 

protected with lint, so as to prevent irritation either if 
the urethral or chancrous discharges: the latter, if any, 
should be immediately covered with lint : in short, the 
surgeon and patient must use as great care and cleanli- 
ness as possible. When the patient has recovered from 
the inflammation, the rest of the operation may be com- 
pleted. 

There are a great many means used for allaying in- 
flammation of these parts by those who are unwilling to 
operate, yet I cannot but think a single and rapid in- 
cision not only entirely safe, but far the best and least 
tedious method of relieving the patient and surgeon from 
a very embarrassing situation. The application of 
leeches is more than questionable ; the irritation and 
pain of their bites far exceeds the benefit ; and all kinds 
of injections will soon convince the accurate observer of 
their uselessness. Not so, however, with the immersion 
of the penis in warm water; this is an- agent, not only 
mild but efficient, from its relaxing effect ; it is in our 
hands only a preparation for the incision, as this is ne- 
cessary to prevent a recurrence of the evil, or what is 
worse, the supervention of paraphimosis. 

This, when it unfortunately occurs, is, as we said be- 
fore, brought about by the complete retraction of the 
prepuce behind the glaus, or its projecting edge, which 
is called from its encircling this part, the corona glan- 
dis. It is a disease that calls for immediate relief, be- 
cause it will otherwise by completely strangulating the 
glans, which is highly vascular, prerent the return of 
its blood for so long a period, as to cause mortification 
and its entire loss. Thi& same difficulty occurs in 



CFRCUMCISIOM. 1G3 

children from means entirely artificial ; for they mis- 
chievously tie strings around the glans, and have been 
known to endure the torture of complete mortification, 
rather than expose their mischief. The string, of course,, 
must be severed. 

The other may, if attempted early, be relieved with- 
out an operation, thus : the surgeon is to place his two 
thumbs side by side upon the glans, and his two next 
fingers of each hand on the sides of the penis, steady 
and continued pressure thus made for a sufficient period, 
will gradually force out from the glans enough of its 
blood, to permit the stricture to be brought forward ; as 
soon as it slips over the corona glandis, the surgeon is 
to desist from pressure. He will of course use his judg- 
ment, and divide the stricture at once as a method far 
less painfuJ v should he be called so late that the conges- 
tion of the glans is very great, and the pain from pres- 
sure excessive. Should there not be a reasonable 
chance of success it will be right to do this at once, as 
the pressure will only increase the pain and swelling, 
and hasten mortification. 

Nothing is more common to the practical surgeon 
than these affections, and there is no doubt that the hu 
mane and enlightened rite of circumcision, if practised on 
all male children, would render them very infrequent, 
as they are generally caused by a preternatural elonga- 
tion of the prepuce ; this, though always done to all 
Jewish male children, is of course adapted in extent to 
the case, some requiring the removal of much more than 
others : the method adopted is admirably calculated to 



164 



CIRCUMCISION. 



produce uniformity in the result, and surgeons would 
cheerfully adopt it if suited to the adult. 

But we are not only to view the ceremony of the 
Jewish people as preventive of these two annoyances ; 
there is no doubt that it would prove a most effective 
means in preventing the spread of syphilis. If the view 
we have taken of that disease be correct, viz. : that it is 
produced by a union of foul secretions of both sexes, 
the reader can at once see that a shortened prepuce, by 
facilitating the removal of the secretion that is constantly 
accumulating about the glans, it must be a great pre- 
ventive measure: it is very evident that the actual dis- 
lodgement of the syphilitic poison by immediate ablu- 
tion, is the best means of preventing its absorption ; the 
frequent occurrence of chancres in the folds of the pre- 
puce and upon the glans, shows that its presence is' cal- 
culated to facilitate the contraction of the poison. 

It may naturally occur to some that this elongation 
of the prepuce cannot be a natural deformity, as its fre- 
quency renders it utterly disproportionate to other de- 
partures from the natural state ; nor is it so : it is 
doubtless often produced by the mischievous desire of 
the child to be constantly meddling with this part, and 
finding that it yields readily and without pain, it becomes 
quite a pleasant diversion ; every boy is familiar with 
the experiment of holding the prepuce together, and then 
distending it with urine. 

The absurd and culpable fingering of nurses and vul- 
gar mothers, is a matter that cannot have escaped the 
notice of the observing physician. With what object 
this can be done on a delicate infant heaven only knows ; 



CIRCUMCISION. 165 

whether to minister to a filthy and prurient imagination, 
or to effect some profound and wonderful benefit, is un- 
known to the writer, for he has never been able to elicit 
a confession of the motive ; the fact however is undoubt- 
ed, and it only serves to show the importance of direct- 
ing popular attention to the physical treatment of infants. 
Nothing should escape the notice of the philosophical 
physician, and whatever can cause the complete physi- 
cal development of a perfect human being, is so much 
added to the well-being of the general humanity. 



CHAPTER X. 

SWELLING AND OTHER ENLARGEMENTS OP THE 
TESTICLE. 

As it is our design to connect as far as possible those 
diseases that are consequent upon or produced by syph- 
ilis or gonorrhea, we pass over the other congenital mal- 
formations of both sexes, leaving them for future con- 
sideration. 

It was observed when speaking of the radical cure of 
gonorrhea, that injections were supposed, by stopping 
the discharge from the urethra, to produce swelling of 
the testicle : this does not apply to those cases in which 
the injection is used upon the first appearance of irrita- 
tion, before the discharge is established, but after it has 
been running for a few days. The writer is far from 
wishing to deny this, on the contrary he believes it occa- 
sionally does so ; with him, however, it becomes a mere 
calculation of profit and loss to the patient ; shall the 
discharge be permitted to go on with the certain result 
of a great deal of distress, and the great probability of 
stricture, and as we shall soon see, Unit of swelled tes- 
ticle too, whether the injection is used or not, or shall 
we endeavour to secure him from these evils, with the 
remote possibility of a slight swelling of the testicle, 
easily reduced by appropriate remedies? For ourselves, 



SWELLED TESTICLE. 1C7 

we choose the latter, and we have no doubt the patient 
would also, if he knew the contingencies of suffering the 
discharge to continue, and the great distress often 
produced by giving medicines for gonorrhea by the 
mouth. 

Moreover, injections are not the only cause of this 
evil; if we wish to avoid all the exciting causes, we must 
cease the mechanical treatment of strictures entirely, 
for swelled testicle is excited by any thing that produces 
irritation in the urethra, gonorrhea itself being by far 
the most active cause. The first symptom the patient 
observes, after the disappearance of the discharge from 
the urethra, is a sharp pain in one of the testicles, 
shooting up along the cord to the groin, and then to the 
back. 

It often happens that the testicle swells very sudden- 
ly to the size of a hen's egg, and occasionally the cord, 
through which the semen passes up into the groin, be- 
comes swollen to the size of the little finger: this is not 
frequent however : the testicle is exquisitely sensitive, 
fever accompanies, and the patient is obliged to lie down 
as the weight of the gland is insupportable. There is 
often an annoying rolling of the testicle, caused Dy the 
action of the muscular tissue of the scrotum : the swell- 
ing of one testicle sometimes subsides suddenly, and it 
attacks the other , both are rarely affected at once. 

Although there are several other enlargements of the 
testicle, and of a very serious nature, it is unnecessary 
to mention them here ; the surgeon will always recog- 
nise this to be the swelled testicle only, from the sud- 
denness of its attack as well as its occurrence simulta 



168 SWELLED TESTICLE. 

neously with, or immediately on the subsidence of gon 
orrhea. 

There is an appendage to each testicle, called by sur- 
geons the epydidimis, which it is unnecessary furthei 
to define, thin to say, that it is a convolution of the nu- 
merous tubes, of which the structure of the testicle is 
composed, appended to its outside, and from which the 
cord proceeds ; all these tubes uniting in it, and ascend- 
ing singly the groin. In this substance there may re- 
main a considerable degree of hardness, after the swell- 
ing of the testicle subsides ; it need excite no apprehen- 
sion, as it neither decreases or impairs the functions of 
the gland. This is often a source of great annoyance 
to the patient ; he may rest assured, that it is exceed- 
ingly common in many, whose numerous families often 
induce them to wish that it had somewhat impaired their 
procreative ability. 

The treatment of this affection consists of leeches, in 
sufficient number to produce a decisive effect — that is, 
from fifteen to twenty, — nauseating doses of antimony, 
and evaporating lotions. The judicious surgeon will not 
attempt, by inserting bougies into the urethra, to bring 
back the discharge, as was the custom in the olden time, 
because this irritation would not only fail to effect the 
end in view, but it might prove highly efficient in con- 
tinuing the disease. Purgatives are also used, when 
judged proper, and the pain may be relieved by injec- 
tions of laudanum, by the rectum, as in gonorrhea. 

There is a substitute for leeches, that may be adopt- 
ed, if they are not to be had, viz. passing a ligature 
round the scrotum, as we do around the arm, in bleed- 



SARCOCELE. 109 

ing, and opening the veins in several places, with the 
lancet. Immersing the scrotum in warm water, will 
facilitate the flow of blood. This disease is quite a 
common attendant on mumps, particularly in children. 
The treatment, if any is required, is the same. 

Although it has nothing to do with syphilis, still there 
r4 a swelling peculiar to that state. The precursor of 
tne affection, whether chancre or gonorrhea, will suffi- 
ciently indicate its nature to the patient. 

Sarcocele. — So far, we have confined our attention 
to those diseases of the genital organs, more immediate- 
ly connected with venereal complaints. We shall now 
speak of those they share in common with other parts 
of the body. Both the penis, and its appendages, are 
liable, from the peculiarity of their structure and func- 
tions, to some affections of a malignant and obstinate 
character. And we regret to say, that in consequence 
of their incurability by other means, they often come 
under the notice of the operating surgeon. 

To avoid unnecessary subdivision, we will continue 
our remarks on diseases of the testicles. In designating 
the diseases, we shall use the scientific terms, explain- 
ing them immediately, so as to adapt them to popular 
comprehension, and enable the patient to use his own 
knowledge, in speaking to his surgeon, or to detect 
quackery, should he be so unfortunate as to fall into 
such hands. The intelligent attendant will not fear 
discovery ; he has nothing but truth and science to be 
discovered. The sooner the quack is detected, the bet- 
ter for the patient and society. 
15 



170 



SARCOCELE. 



The first and most common of the permanent en- 
largement of the testicles, is one of a fleshy and unma- 
lignant character. It is called sarcocele, from two 
Greek words, <jap£, flesh, and xr^, a tumor. A uthors 
make a distinction, in this disease, between an affection 
of the body of the testicle, and the appendage described 
when speaking- of swelled testicle, called the epydidi- 
mis, alleging the latter to be much more easy of cure 
than the former. The truth is, that sarcocele of the 
testicle is xcry rarely cured, and the thickening of the 
epydidimis is, as we said before, not often troublesome. 
We believe them to be, in the great number of cases, to- 
tally different diseases. 

Sarcocele approaches very insidiously, commencing 
with little or very dull pain. It is a gradual enlarge- 
ment and hardening of the testicle. It preserves its 
form, and may last for years — its principal inconveni- 
ence being the increase of weight, which is generally 
alleviated by wearing a suspensary bandage. The first 
appearance of pain of a severe kind, passing up the 
cord to the groin, usually attracts the patient's renewed 
attention, after it has been stationary for months, and 
perhaps years ; and it is then found that the cord itself 
is enlarging. There is now no time to be lost; surgi- 
cal aid becomes immediately necessary. In this state 
of things, castration is the only remedy. 

On the first appearance of the disease, the applica- 
tion of leeches is usually presevered in for a longtime; 
yet I have never seen the slightest benefit from them. 
Mercury has been applied to them, in every formula, 



SARCOCELE. 171 

and it is said, with occasional benefit. It has also been 
administered with cicuta, by the mouth. But the prep- 
arations of iodine merit, by far, the most attention. The 
success of this remedy, in my mind, confirms the idea 
of the frequency of the scrofulous nature of sarcocele. 

Were I the subject of a disease of this kind, I would 
submit my case entirely to this remedy, until the slight- 
est enlargement of the cord, satisfied me there was no 
alternative but the knife. In all diseases of the testicle, 
great care must be taken to distinguish enlargement of 
the veins of the cord, from permanent or structural 
change. See hydrocele of the cord. 

There is no doubt a predisposition in families to these 
affections. I have removed no less than three testicles, 
affected with sarcocele, from brothers, in this city. 

There is nothing of the syphilitic character in this dis- 
ease. The swelled testicle alluded to, when treating 
of syphilis, is undoubtedly syphilitic, and can only be 
successfully treated by mercury ; whilst that medicine 
has very little effect in this. There is nothing to pre- 
vent a person from having a sarcocele, who has had 
syphilis ; yet a far greater number who have never had 
any symptom of the latter, have the former. 

Although, like all glandular parts, a simple sarcocele, 
that often remains quiet for years, may suddenly degen- 
erate into a malignant disease, requiring immediate ex- 
tirpation, to preserve life, still, in the commencement, 
there is no danger of mistaking these diseases. The 
only affection liable to be confounded with it, is one with 
which, in its more advanced stage, it is often united, viz. 



172 HYDROCELE. 



Hydrocele. 

Each testicle is surrounded with a separate membra- 
nous sack, attached to its posterior part, and moistened 
only, on its inner surface, with a slight exudation, we 
may say, to prevent friction.* This is sometimes pro- 
duced in excessive quantity, even to a quart in amount, 
and constitutes the disease called Hydrocele. It is de- 
rived from the Greek words, v 8o>p, water, and xr^, a 
tumor. We shall give the distinguishing characters of 
this, and the last affection, as we proceed in its de- 
scription. 

Persons, at every period of life, from infancy to ex- 
treme old age, and in every state of health, are subject 
to this disease. It usually exists on one side, though 1 
have several times had occasion to operate on both. Its 
causes are not known, though it is observed to be often 
the seeming result of attrition ; such as ride much on 
horseback, being more liable to it. It is entirely of a lo- 
cal nature, and not connected, in any way, with gene- 
ral dropsy. It would always present a transparent ap- 
pearance, when held behind a candle, in a darkened 
room, were it not for the very variable thickness of the 
membrane, that contains the water ; and this latter cir- 
cumstance, also, renders it very liable to be mistaken 
for sarcocele. 

Both these diseases begin at the lower part of the 
scrotum, but as the testicle enlarges in sarcocele, it pre- 

* The testicle itself, is immediately covered with a duplication of 
the same membrane, closely attached and identified with its proper 
•ubstance. They slide upon one another. 



HYDROCELE. 173 

serves its oval form, whilst the hydrocele assumes the 
pyriform shape, with its larger extremity downwards, 
that being the natural formation of the sack that con- 
tains the water. If transparency exist, it is certain evi- 
dence of water ; but the sarcocele itself, may be com- 
bined with hydrocele. 

Sarcocele, when alone, is usually much harder than 
hydrocele, and when held in the hand, is heavier than 
it. In hydrocele, from the natural attachment of the 
sack, to the posterior part of the testicle, the water can- 
not cover it there, and when pressed upon, at the lower 
and back part of the scrotum, the testicle can be made 
to feel pain, whilst the other part of the sack, with the 
water intervening, renders it insensible to considerable 
pressure. 

A hydrocele, although softer than a sarcocele, and 
yielding to pressure, is sometimes less so, from the 
thickening of the sack, especially in old cases: whilst 
some parts of a sarcocele may be much softer than oth- 
ers, thus resembling water. The upper part of the cord, 
in many cases of sarcocele, is much thickened, and 
then there is every reason to suppose it a sarcocele. 
This is the best symptom, by which to ascertain its na- 
ture, in combination with hydrocele. In this complica- 
tion, the sarcocele is the first complaint, and can be 
distinguished satisfactorily, before the hydrocele ap- 
pears. Hydrocele will soon obliterate the folds of the 
scrotum, and it will extend to the ring, or opening in 
the abdomen, surrounding and preventing the cord from 
being felt. Sarcocele leaves the cord perfectly palpable 
to the touch. 

15* 



174 HYDROCELES OP THE CORD. 

Rupture, or hernia as it is called by surgeons, may 
be complicated with these complaints, more especially a 
species common to children, and in the event of an 
operation either to cure the hydrocele or discharge the 
water, the deplorable result of puncturing the intestine 
might follow and death occur, or a false passage for the 
foeces. Hernia always comes from the groin and pro- 
ceeds downwards ; it is therefore thickest above, whilst 
the water in this species of hydrocele always begins from 
below ; moreover the hernia may be reducible, or capa- 
ble of being put back into the abdomen. This is a suf- 
ficient criterion in this variety. There are others, how- 
ever, which exist in various parts of the cord and even 
penetrate the abdomen through the ring. These are 
termed 

HYDROCELES OF THE CORD. 

When surgeons speak of the cord, they allude to the 
duct that conveys the semen from the testicle, up the 
scrotum, into the ring or opening on the side of the 
penis, into the abdomen, and so downwards into its re- 
ceptacles on the sides of the bladder, and thence into 
the urethra, whence it is expelled by appropriate mus- 
cles during coition. There is one of these ducts, ac- 
companied by an artery and vein, to each testicle ; they 
are surrounded with what we have already described as 
the cellular tissue that connects every part of the body, 
and a continuation of the same sack that contains the 
water of the hydrocele last described ; this extends from 
the testicle to the ring ; then enclosing all, a cylindrical 
muscle whose duty it is to suspend the testicle. Thus 



HYDROCELES OF THE CORD. 175 

it will be seen that the cord has three coverings ; they 
all come out of the aperture or ring by the side of the 
penis, enclose the cord, and go to the testicle. 

The cellular tissue investing immediately the cord, is 
in a natural state extremely delicate, consisting of cells 
scarcely visible to the naked eye, but when filled with 
the fluid of hydrocele they become much larger ; in this 
hydrocele the water goes from the testicle to the ring : 
it cannot surround the former as in hydrocele of the tes- 
ticle, because there is the adhesion we have spoken of, 
and this produces the distinctive term, hydrocele of the 
cord. 

From its going into the ring it may be confounded with 
a species of rupture, for as we said before they all come 
through the ring ; from this it is distinguishable by close 
attention, in the following way ; when the patient lies 
down, the hernia or rupture may be returned into the 
abdomen ; the hydrocele cannot, for it is sealed up 
within the cells of the cord. Should the rupture be ad- 
herent or grown fast, this mode of determining it is im- 
possible, and all must then depend upon the tact of the 
surgeon. There is a disease of the veins of the cord 
called varicocele, in which they enlarge like a bundle 
of earth-worms ; this disappears when the patient lies 
down, besides it rarely goes higher than the ring, unless 
combined with other disease of the cord. These two dis- 
eases may also co-exist, and then the tact only of the sur- 
geon can discriminate them. 

ENCISTED HYDROCELE OP THE CORD. 

It sometimes happens that a hydrocele occurs in an 



176 ENCISTED HYDROCELE OF THE CORD. 

isolated portion of the cord : this is caused by a fortui- 
tous adhesion of the investing sheaths both above and 
below, suffering the water to accumulate in their inter- 
vening portion. This variety occurs oftener in children, 
but is not as common as the others ; the estimates of 
European authors with regard to its frequency will by 
no means apply to this country. Richerand considers 
it to occur in the proportion of one to two hundred ; 
now as the writer has often seen it, this cannot be cor- 
rect, as we do not see the other varieties by hundreds, 
though they are not infrequent. 

It undergoes no alteration from change of posture, 
and is, like the others, productive of no pain in hand- 
ling. The testicle is perfectly distinct below, and the 
cord above, between the swelling itself and the groin ; 
yet there are occasional exceptions to this : a distin- 
guished surgeon of this city requested me to examine an 
infant in whom an incisted hydrocele was so high up 
the cord that it went into the ring, and might upon an 
ordinary examination have passed for a rupture : by 
placing the hand on the abdomen and pressing the con- 
tents downwards, no additional tension or protrusion 
was caused, which must have been the case had it been 
a hernia; darkening the room and holding a lighted 
candle near it, whilst it was viewed through a thick roll 
of paper forming a tube, and placed directly upon the 
tumour, showed its transparency, the tumour appearing 
like a yellow grape : this is as we said before decisive 
of all hydroceles; it proves them to contain water. 

The prudent surgeon will always remember that 
other affections such as hernia, may exist in a very dan- 



ANASARCOUS HYDROCELE. 177 

jrerous contiguity : he will therefore use all his tact in 
the examination, and it will reflect credit on his head 
and heart, and add to his peace of mind if he avails 
himself of other eyes and fingers than his own ; in dif- 
ficult cases when a surgeon has been intensely occupied 
with " making his diagnosis," both his touch and his 
perception generally become confused, from too close at- 
tention to one object, and a fresh head and touch will 
often discover an error, or confirm a doubt ; but let him 
call in a head and heart he actually -knows to be under 
proper and manly influences, or he will only add to his 
own annoyance, and endanger his patient. There is 
one other species of hydrocele ; it is called 

Anasarcous Hydrocele, — from ava, through, and 
crapi, flesh, because unlike the others it is not contained in 
a sack, nor confined to one side; but distributed directly 
under the skin through the whole connecting tissue, and 
distending the scrotum, yet showing a dividing line into 
two equal halves, caused by the seam that separates this 
part. It extends also to the penis, because the cellular 
tissue of these parts is continuous ; the appearance of that 
organ is very disagreeable, the whole body and prepuce 
being greatly enlarged and distorted. This disease, un- 
like the others, is almost always dependent upon a general 
dropsy or anasarca of the cellular tissue of the entire 
body, and it therefore comes more especially under the 
notice of the physician ; it sometimes happens that its 
distension is so enormous as to require puncturing ; this 
however is within his province. The treatment is con- 
stitutional entirely. There are rare cases in which a 
local affection of this kind is brought about by the fric- 



178 HEMATOCELE. 

tion of clothes or irritation of the urine ; to cure these 
the cause must be removed and they will subside. 

These constitute the varieties of hydrocele. We have 
purposely omitted the treatment till the last, that we 
might give uninterruptedly their distinguishing charac- 
teristics : collectively they are diseases of great frequen- 
cy, though the first largely predominates. Their treat- 
ment can be made very satisfactory, as they are by the 
resources of modern surgery, when uncomplicated with 
disease of the testicle or other parts of the system, capa- 
ble of almost certain and permanent cure, and that too 
without danger. 

There is a disease precisely analogous to hydrocele 
of the sack containing the testicle, and also to the ana- 
sarcous hydrocele of the scrotum ; it is termed 

Hematocele, — from a^a, blood, and xaa.»7,a tumour; 
and consists of blood either in the sack, or in the cellular 
tissue of the scrotum ; the latter is quite common, and 
often originates from blows and accidents : there is also 
a rupture of the spermatic or vein of the testicle, with- 
in the sheath of the cord, originating in the same 
causes, as well as wrestling and straining, &.c. The 
former oftenest occurs from the puncture made in evac- 
uating a common hydrocele, the sack of which from 
long continuance is covered with enlarged veins ; these 
cannot be distinguished, and are pierced with the lancet 
or trochar : the surgeon will not know it, till the water 
is principally evacuated, when blood will issue, and oc- 
casionally after all the water is drawn off, the sack will 
fill in a day as large as before ; this of course can be 



HEMATOCELE. 179 

notning but blood, as the water would require more time 
to accumulate. 

In cases where the vein ruptures within the sheath of the 
cord, and occasionally, as it does, quite near the ring, dur- 
ing wrestling or straining, there may be difficulty in distin- 
guishing it from rupture, or hernia of the gut, as it oc- 
cupies the very position, and occurs under circumstan- 
ces oftener productive of the latter disease, than the rup- 
ture of the veins. The tact of the surgeon can alone 
make out this case. I do not approve of hasty incisions, 
in these cases, as I have found them generally do well 
under rest, and the external application of a wash of 
sugar of lead. If the distension is very great, it will be 
necessary to lay open the swelling with the knife, and 
remove the coagulated blood. The cavity should never 
be filled with lint, particularly if the accident has been 
consequent on the puncture used for injecting the hy- 
drocele, as it is then supposed to be under the influence 
of inflammation, caused by the stimulating fluid, and 
lint would produce unnecessary irritation, and perhaps 
inflammation of the testicle. The lead wash is all suf- 
ficient. Hunting for arteries, in these cases, is general- 
ly lost time. There can be no real occasion for the lig- 
ature, unless the spermatic artery itself be wounded. 

Treatment of Hydrocele. 
Although hydrocele, of the vaginal coat, as it is call- 
ed by surgeons, (the one first described,) is not a dis 
ease of any danger, still its position and extreme m 
convenience, obliging the patient from its bulk and 
painful draggingon the cord, to wear a suspensary band- 



180 TREATMENT OF HYDROCELE. 

age, together with other obvious annoyances, renders 
patients usually very anxious for relief. 

Before speaking of the radical cure, we may notice, 
that the water can at all times be let out with a com 
mon lancet, though it will almost invariably re-accumu- 
late in a few months. Again we caution the patient 
never to submit to even this simple operation, without 
well placed confidence in his surgeon ; for, let him re- 
member, it may be a hernia, and then, if punctured, he 
has to choose between death and an artificial anus, a 
loathsome state indeed. In patients who are at all deli- 
cate, perfect rest must be enjoined, till the puncture 
heals, otherwise inflammation and great trouble might 
ensue. A radical cure has been known to follow this 
operation, though that is very improbable. 

No less than six different methods have been employ- 
ed by surgeons for the cure of this hydrocele. The 
practical surgeons now confine themselves, almost ex- 
clusively, to two, viz. the injection of an irritating fluid, 
to produce sufficient inflammation to alter the action of 
the vessels that produce the dropsy, and incision, filling 
the wound with lint, the mechanical irritation of which 
will cause the same result, or complete adhesion and 
closure of the sack. Both these methods are desirable, 
yet as the first is much the most so, there must be some 
especial reason for occasionally adopting the latter. We 
will state our own practice, and reasons for adopting 
either. 

In a case of hydrocele, with a sack sufficiently thin 
to admit of a ready examination, for ascertaining its 
simple state, the certainty of the absence of hernia, and 



TREATMENT OF HYDROCELE. 181 

the exact position of the cord and testicle, we invaria- 
bly practice the injection. In one much the reverse of 
this, we should choose the latter, as far the safest opera- 
tion for such a case ; for, if it should have a thick 
sack, and it reach as high as the ring, which large ones 
often do, we could neither pronounce positively on the 
healthiness of the cord and testicle, nor the absence of 
hernia. An injection would greatly irritate a diseased 
testicle, and the puncture might be fatal in hernia. 
Moreover, in a case of doubtful nature, as to the' kind 
of affection, or whether any exist of the testicle, it is our 
duty to represent to the patient beforehand, the propri- 
ety of continuing the incision, and removing the disease, 
should we discover cause to do so. 

In the event of using an injection, a variety of sub- 
stances have been adopted. Port, or red wine, diluted 
to various degrees, has found advocates in great sur- 
geons. Sir James Earle uses two thirds of wine to one 
of water. Sir Astley Cooper uses a drach. of sulphate 
of zinc to a pint of water. This we prefer, as it is defi- 
nite in strength, wine often differing. Of late, the use 
of iodine, variously diluted, has found many advocates, 
and, from the high testimony in its favour, is probably 
a good injection. The time the injection is to be per- 
mitted to remain in the sack, may vary. I have known 
some persons so susceptible to pain, that I feared 
too much inflammation. Five minutes is the average. 

It is introduced by means of a canula and trochar, a 

small piercing instrument, surrounded by a silver tube. 

This is so adjusted, that it enters with perfect ease. 

The surgeon, feeling for the position of the testicle, 

16 



182 TREATMENT OF HYDROCELE. 

takes the scrotum in his left hand ; lie applies his :ro. 
char very suddenly, at an angle with the skin about the 
eighth of a circle, pointing towards the body, and guard- 
ing it always with his thumb ami two fingers, so that it 
cannot enter the cavity over an inch. This ensures the 
testicle from danger. He must take great care to apply 
it at a proper angle with the skin, for if he passes it too 
obliquely, it may go entirely between the skin and sack, 
and not enter the latter at all. Again, should it be re- 
placed, after accidentally coming out, when the water 
is all drawn off, and enter this tissue, the result would 
be deplorable, for excessive inflammation and mortifica- 
tion of the scrotum would probably ensue, because the 
injection would enter the cellular structure, whence it 
could not be withdrawn. 

When the trochar is withdrawn, the contents of the 
sack issues through the silver tube, which is suffered to 
remain, the surgeon keeping his baud upon it, so as to 
prevent its being pressed out by the scrotum, which con- 
tracts as the water issues. As soon as it is all out, or 
OS near as may be, the solution designed to be injected, 
is sucked up in an India rubber bag, fitted with a noz- 
zle that will just enter the mouth of the tube, and beinc 
compressed slowly with the right hand, it enters the 
sack. It need not be distended to quite its former size. 
Enough has entered when we are certain it has touched 
every part of the sack. It is to be withdrawn through 
the tube, on which the surgeon has kept his finger dur- 
ing its continuance. 

The patient experiences more or less pain in the scro- 
tum, groins, or back, and is to remain perfectly still in 



TREATMENT OF HYDROCELE. 183 

bed till the inflammation goes down. It is rarely so 
high as to require leeching ; I have usually found evap- 
orating lotions of spirit and water sufficient, and per- 
haps a saline purgative ; the diet must be rather low, no 
meat or stimuli for a few days, when the patient may 
cautiously resume his former habits. A cure is almost 
invariable on the first trial ; should it be unsuccessful, 
it may again be tried either with a stronger solution, or 
one of a different kind. In a great number of cases in 
oui own practice and that of our friends, we have never 
known the zinc solution thus used to fail. 

The second method or the cure by incision, I am 
aware has received the disapprobation of some distin- 
guished surgeons; yet the proper substitute has not been 
given by them. The fact of the frequent impossibility 
of determining the soundness of the testicle in conse- 
quence of the thickness of the sack, is sufficiently evi- 
dent from the admissions of every practical surgeon ; 
and its occasional thickness may be judged of from the 
circumstance of the whole sack including the testicle, 
having been removed in an adjoining city under the im- 
pression that it was the testicle alone, the latter being 
discovered perfectly sound upon laying open the tumour 
with the knife ; this was not done by a surgeon without 
practice, by any means, and although it is not likely to 
prove a frequent result, it is better in doubtful cases to 
avoid its possibility. 

It is conceded that the patient's life often depends 
upon discovering disease of the testicle, and in these 
cases the incision had belter be made, if only for that 
purpose ; besides, as we said before, should there be no 



184 TREATMENT OF HYDROCELE. 

hydrocele, the incision is precisely what is necessary 
when prolonged, for the removal of the gland. The 
mode of doing either is known to every practical sur- 
geon and need not be here described. If hernia is 
suspected great care is necessary. Should the testicle 
be sound, the opened sack is to be rilled with lint and 
allowed to suppurate : it will always prove a radical 
cure ; the method is much more severe and will never 
\>e chosen either by the surgeon or patient when avoid- 
able. 

There is very little to be said on the subject of the 
cure of both the other varieties or hydrocele of the cord ; 
that which extends over the whole cord is sometimes 
troublesome from its bulk : an incision of its lower part 
has often been followed by a cure. It is the method 
recommended by the best surgeons and they only differ 
with regard to its extent. I would not advise it to be 
made over one third the length of the hydrocele ; it is 
fortunate that the cord usually lies on the back part ; 
as the contents of this will partially recede on the pa- 
tient's lying down, the surgeon can then have an oppor- 
tunity of handling the part, so as to determine where the 
cord is : he should then make a puncture only, and by 
drawing off the water, can determine that fact before he 
prolongs the incision ; this we would urge always to be 
done, otherwise the cord might be divided, and the tes- 
ticle of that side rendered useless. A director may be 
introduced, and the rest of the incision made upon that 
so as to ensure its safety. The same practice and cau- 
tious regimen apply to the encisted hydrocele. I have 
operated only on one case by injection, in consequence 



TREATMENT OP HYDROCELE. 185 

of its size ; the incision is the usual practice. In chil- 
dren a mere puncture will suffice, and they often disap 
pear by using a little severe friction with the fingers, and 
applying a lotion of alum water. 



CHAPTER XI. 

MALIGNANT OR CANCEROUS DISEASES OF THE TESTICLE 

We selected sarcocele as the commencement of our 
description of diseases of the testicle, because it is the 
most simple of those affections that require extirpation, 
and may properly be viewed as the foundation of many 
tl\at subject the patient to that sad result. It would have 
been a natural arrangement to have proceeded at once 
with the others, or those which form the subject of this 
chapter: in suffering hydrocele to intervene, we were 
governed by the desire to save repetition, as it is abso- 
lutely necessary to know the symptoms of those two af^ 
fections, before the surgeon can determine the nature of 
such as we are now about to describe, and it is vitally 
necessary that it should be early determined, as an op- 
eration rarely avails after the least enlargement of the 
cord ; for we say emphatically, in order that the patient 
may be impressed with the only true principle to govern 
himself in so painful a situation, whatever your disease 
may prove to be after it is removed, let that be done in 
all cases, where the cord becomes enlarged^ in all chro- 
nic affections of the testicle. 

As a matter of course every man upon the first ap- 
pearance of disease in this part wishes to persuade him- 
self it is not incurable, and his physician, if he possess 



DISEASES OF THE TESTICLE. 18? 

any sympathy, is very apt to acquiesce in his patient's 
conclusion : let them both proceed in comforting them- 
selves and in the use of remedies, but let them watch 
the cord. We will suppose the patient to have a sarco- 
cele of the most simple character : he goes on with the 
use of remedies, and, persuading himself it is diminish- 
ing, neglects to report himself to his physician ; after a 
while he appears, and the physician's perception of the 
"feel of the part" having been sharpened by his pa- 
tient's absence, he fancies he can detect increased hard- 
ness of one part, and softness of another : the patient 
has had a few sharp pains, and the cord is very slightly 
enlarged : his general health is good. Now what is to 
be done 1 God forbid that I should advise rashly in a 
matter so trying to the feelings of any man : but there 
is no alternative. I have more than once been blamed 
for advising an operation, but I have seen the patients 
submit to it when it was too late, and death soon fol- 
lowed. 

There is a great discrepancy of opinion on the sub- 
ject of cancer whether it is ever local or entirely dis- 
connected with constitutional disease, or according to 
the old fashioned but expressive phrase, in the blood : 
if I may venture an opinion, the result of close observa- 
tion in a city where cancer is very common, I would 
make this distinction, premising that, it does not apply 
to the varieties of cancer termed fungus, soft, &c, but 
to simple schirrus. A cancer is likely to return after 
removal, precisely i > proportion to its nearness to the 
centre of the circulation ; not that the writer knows or 
supposes any especial influence exerted by the heart, in 



188 MALIGNANT OR CANCEROUS 

one place more than another : it is a mere matter of o 
servation and experience ; he has no recollection of <i 
fatal case of cancer of the lip, removed at a time when 
the progress of the disease rendered it at all proper to 
do it, none of the face, and where it has attacked the 
extremities including the testicle, and it has been done 
early, the result has likewise been favourable. 

How sadly different those of the female breast, and 
of the neck. If left long enough to make their nature 
at all probable, they have assumed a disposition to ad- 
vance, which is almost invariably fatal ; nothing but the 
earliest extirpation gives any chance of life, and even 
then there is the greatest doubt. There are some gen- 
eral observations on the subject of health that may here 
be given, though the appearance of a patient that will 
not admit of an operation can only be determined by 
much practical observation. 

Mr. Pott, a distinguished British surgeon, remarks, 
" a pale, sallow complexion in those who used to look 
otherwise, and loss of appetite and flesh without any 
acute disorder ; a fever of the hectic kind, and pain in 
the back and bowels, in those afflicted with disease of 
the testicle, are such circumstances as should induce a 
suspicion of some latent mischief in some of the viscera." 
He means mischief of a similar character, and then an 
operation would of course be unavailable. 

There can be no doubt of the propriety of removing 
any testicle, however seriously diseased, if the general 
health be good, and the cord sound : yet here an allu- 
iion must be made to a disease not yet described ; it is 
exceedingly common and may be supposed to form an 



DISEASES OF THE TESTICLE. 189 

insuperable obstacle to an operation. It is, however, 
not so, and can always be detected by the surgeon. 
The disease alluded to is termed varicocele, or an en- 
largement of the veins of the cord : it is so common 
even when no complaint of the testicle exists, as to af- 
fect more or less one man in every three, and is often 
so bad as itself to require an operation. See that 
Chapter. * 

In all diseases of the testicle, particularly those which 
produce from their weight much dragging upon the 
cord, these veins are apt to be obstructed and much dis- 
tended with blood, producing a knotty feeling, which 
also exists in cancer ; but it is a hard and knotty feel- 
ing, and is not removed upon lying down : it is as ap- 
parent in the morning as at night ; varicocele disap- 
pears entirely upon assuming the recumbent position, 
and is always soft. Moreover the membranes that in- 
vest the cord, are thickened and hard in cancerous dis- 
eases, and affected with sharp pains not much relieved 
upon lying down. All these symptoms sufficiently in- 
dicate incurable disease. There is moreover a deposit 
of water existing in several of the cells of the cord, and 
a thickened state of them combined with it : this often 
causes an appearance of malignant disease and produ- 
ces great alarm in the patient when he learns the seri- 
ous nature of the symptom. The surgeon should ex- 
amine the cord carefully, and if necessary puncture it 
in several places; this, by evacuating the water, may 
simplify the case, and induce the patient to submit to an 
operation which would otherwise appear hopeless. The 



190 FUNGUS H^MATODES. 

state of the cord alone is to determine the propriety of 
an operation. 

However dangerous the last described affection may- 
be considered, that we are now to notice is much more 
so, for it is far more likely to return. It requires very 
early removal to offer any chance of success, sufficient 
to induce the patient to submit to an operation. It is 
called the 

Fungus H^ematooes; or soft cancer of the 
testicle. 

This disease occasionally appears in the epydidimis, 
or appendage to the testicle, but oftener in its body. 
Unlike the last disease, it proceeds generally with slight 
pain, and very slowly, till it attains a very large size. 
I have seen them as large as an infant's head. It is 
always remarkably soft and elastic, as though it con- 
tained a fluid. It is often mistaken for a hydrocele, 
though it is quite destitute of transparency, and always 
much heavier. A hydrocele begins at the bottom, and 
extends upwards to the cord. This generally involves 
the whole, at a very early period. The testicle finally 
ulcerates, but no fungus appears, as in the next describ- 
ed disease. Frequently the glands of the groin acquire 
an immense size, and soon mortification follows. Life 
is then cut short rapidly. 

This disease is more frequent in young people. Hard 
cancer, in the old, or middle aged. Almost invariably 
the same disease exists in the viscera of the abdomen, 
and an operation is rarely proper. These are the two 
diseases properly termed cancerous. 



GRANULAR FUNGUS OF TESTICLE. 191 

There is another species of fungus growth, the 
granular fungus, proceeding from the investing mem- 
brane and also from the testicle itself. It is not malig- 
nant, occasionally healing up kindly of its own accord 
The causes of this disease, like the others, is involved 
in obscurity. It is sometimes assigned to a blow, and 
occasionally to the ordinary swelled testicle. Its first 
symptom is an enlargement, hard in character, and with 
slight pain. Both increase, till an ulceration is formed, 
and then, instead of matter, a white fungus, like grains 
of rice, appears. Upon the occurrence of this, the pain 
usually subsides, because the tension and pressure of 
the investing coat of the testicle, is removed by the ul- 
ceration. 

Mr. Lawrence remarks, that he can see no reason 
whatever for removing the testicle, in this affection, as 
the growth will invariably subside of its own accord ; — 
yet adds, that it is so slow, that it would probably re- 
quire a very long time. The truth is, it is so slow that 
the patient will not always submit to the inconvenience. 
I was requested by Dr. Sibree, of this city, to remove 
one from a French gentleman, who preferred and urged 
that measure. It is somewhat remarkable that, in this 
unfortunate man, the other was, shortly after, affected 
with a similar disease, and was also removed, in a 
neighbouring city. 

Should the growth proceed from the membrane, a 
cautious dissection will make it apparent, and the gland 
can be saved. If the patient prefer, it will be proper to 
remove the fungus growth, and see if it will heal. If ii 
will not, castration must be performed. 



192 GRANULAR FUNGUS OF TESTICLE. 

Ill concluding this chapter, it is proper to mention 
that the operation of tying the spermatic artery, that 
principally supplies the testicle with blood, has been 
found adequate to check non-malignant disease. Upon 
several occasions I have given the patients that choice. 
Of course, it is done with the express object of cutting 
off the supply of blood, and the testicle will, if it is ef- 
fectual, wither and perhaps entirely disappear. 



CHAPTER XII. 

VARICOCELE ; OR, ENLARGEMENT OF THE VEINS OP 
THE CORD. 

Each testicle is furnished with its own artery, to sup 
ply it with blood, and a vein to return it into the circu- 
lation. When it has performed its duty of secreting 
the semen in the testicle, it is conveyed to its appropri- 
ate receptacles, at the base of the bladder. It mounts 
from the testicles by two tubes, about the bore of an or- 
dinary pin, and composed of a substance of almost car- 
tilaginous hardness, which may be felt in the upper part 
of the scrotum. Each of these tubes originate from an 
immense number of smaller ones, that form the sub- 
stance of the testicles, and each one, with its artery and 
vein, and its investing membranes, forms a cord on its 
own side of the scrotum, ascending as high as the penis, 
on either side of which they enter a small opening in 
the muscles and membranes, under the skin of the groin, 
and dip down to their reservoirs, at the neck of the 
bladder. 

Varicocele, is derived from varix, a vein, and xfay, a 
tumor. It is an enlargement of the spermatic vein, and 
feels exactly like a bundle of earth worms under the 
gKin. The causes of this disease are closely connected 
with its structure, and when we come to examine it, the 
17 



194 VARICOCELE. 

wonder is, that instead of one in three, the proportion 
of those affected does not exceed that number — indeed, 
that any one should escape. 

Both the duct for the semen and the artery, are com- 
posed of strong and fibrous structures, but the veins 
that would seem to require stronger construction, in con- 
sequence of the column of blood they have to raise, at 
least ten inches from the testicle, are formed of a very 
delicate and distensible substance, and on the left (the 
side oftenest affected) are inserted into a large vein, 
within the body, at right angles, thus rendering the re- 
turn of the blood peculiarly difficult. 

Why this is so, it is quite useless to inquire ; the fact 
is evident. The disease is, however, always more 
troublesome to such as make the severest exactions, in 
the way of venery, upon their systems. Either that, 
or any other mode of exhaustion, if Jong continued, will 
produce it, as in those who are much on their feet, or 
pursue very laborious employments. 

Enlargements of the testicle will, as we said before, 
often cause varicocele, and, in such cases, induce the 
belief, without a careful examination, that the cord is 
affected with the same disease. 

Varicocele may attain the size of a hen's e^, and 
cause the greatest distress, producing much elongation 
of the scrotum, and pain in the loins and back, with 
constant weariness and mental depression. The testi- 
cle occasionally wastes . and I have known it entirely 
disappear. 

When varicocele is very large, it greatly resembles 
rupture. Like it, it will dilate when the patient coughs, 



VARICOCELE. 195 

swell in the erect, and retire in the recumbent position. 
Moreover, it is often combined with hernia. This 
would be unfortunate, in detecting the real nature of the 
disease, when an operation is intended, if there were 
not a certain method of proceeding, that assures the sur- 
geon of its real nature. 

In order to convey intelligibly this method, we must 
first remark, that it requires a great deal more pressure 
to compress an artery, than a vein, so as to prevent the 
passage of the blood. Now both the artery that sup- 
plies the testicle, and the vein that returns the blood, 
pursue the same track, through the ring, over a solid 
bone, to be felt on each side of the penis. A hernia, or 
rupture, also goes through the same ring. When the 
patient lies down, the contents of the vein disappear, 
being assisted to flow back into the larger veins, by the 
removal of the gravitation of the blood. The surgeon 
placing his thumb over the ring of the affected side, 
and making pressure enough to keep the blood from 
passing through the vein, desires the patient to arise. 
The pressure not being sufficient to compress the arte- 
ry, the blood readily finds its way into the testicle, but 
cannot return into the abdomen at all, on account of the 
pressure on the vein, so that the varicocele is quite ap- 
parent. If a hernia occupied the scrotum, it cannot 
descend, so long as the pressure is continued, and so its 
existence is also determined. 

The causes we have assigned for the disease, would 
seem to indicate the means most suited for its relief; yet 
it is rarely the case, that peoples' occupations or incli- 
nations are easily changed. Moreover, when the veins 



196 VARICOCELE. 

have quite lost their contractility, it is very doubtful if 
any ordinary measures of precaution would avail. Pa- 
tients find most relief from wearing a suspensary ban- 
dage or bag truss, which are now very well made by 
the bandage and truss makers, in this city. The use 
of cold bathing to the part, twice or thrice a day, is 
productive of much relief. An open state of the bow- 
els, in this complaint, as well as piles, is very important; 
but purgatives are highly injurious, as they break down 
the powers of the body, and increase the disease. A 
little rhubarb may be occasionally chewed, and it is all 
sufficient. 

I have repeatedly seen trusses applied for this dis- 
ease. Such ignorance is utterly unpardonable, as the 
measure is exactly adapted to produce it. It is the 
same thing: as though the thumb of the surgeon, as 
above stated, were continued there. Patients who re- 
quire trusses for rupture, should take care, in their zeal 
to get a good one, that they do not make pressure too 
near the penis, for that is the place in which, if pressure 
be made and continued, varicocele will follow. 

There are several methods by which the cure of vari- 
cocele may be effected by surgical means, but as they 
are not all equally eligible, we shall give an account of 
each and our own experience. 

The first and most elegant method consists in tying 
the spermatic artery, so that when the supply of blood 
is cut off, the veins can no longer be distended, but will 
gradually wither and disappear : it was supposed when 
this was first proposed, that the testicle, if its peculiai 



CURE OF VARICOCELE. 197 

artery was cut off, would also suffer and be absorbed, 
but practice shows a different result:* it is a very safe 
method, and so far as the perfect development of the 
gland would prove the possession of its functions, those 
persons upon whom I have performed the operation are 
not only perfectly cured, but in as perfect a state of vir- 
ility as before. 

The next method has often been done with success, 
though it is a more painful operation than the other. 
A piece of the enlarged vein is cut out at once, and thus 
its continuity being interrupted it shrinks away, with 
diminution of the gland : why it should be so and the 
other not, it is impossible to say. It cannot furnish a 
rational objection to the operation, should there be suf- 
ficient reasons for preferring it to the other, as the dis- 
ease itself when so troublesome as to require an opera- 
tion, is certain to impair the integrity of the gland to 
quite as great a degree. 

The third plan is decidedly more painful than either, 
yet is often chosen because it is not a cutting operation. 
The surgeon secures the cord, with its artery, which ac- 
companies it, closely between the thumb and fore-finger 
of his left hand ; then, with a curved needle, he carries 
a ligature under the mass of veins, puncturing the skin 
on one side the scrotum, and bringing it out just be- 
yond them ; he then returns the point of the needle, still 
threaded, through the same hole where it emerged, in 

* It is strange, tnat this should tbllow in tying the artery for sarco 
cele, and not in varicocele ; probably the vitality is lower in actual dis 
ease of the gland. 

17* 



198 CURE OP VARICOCELE. 

front of the veins, yet under the skin, bringing it out of 
the same hole where it entered. It is now evident that 
the veins are all enclosed in the loop of the thread, un- 
der the skin. Upon tying the two ends very tightly, 
the same result follows as in the last operation. 

Sir Astley Cooper suggested the removal of a large 
portion of the scrotum, supposing that the increased 
constriction of the veins, by the reduced integument, 
would support them. It is exceedingly severe, and 
in the few instances it has been done, utterly unsuc- 
cessful. 

I have adopted, for the cure of varicocele, a plan that 
has been successful in several instances, and have ap- 
plied the same treatment, to cause the retention of a 
rupture, after its reduction, and with similar success. It 
was proposed originally for the latter complaint. There 
is little doubt of the extensive utility of this method of 
treatment. It is perfectly safe, and by no means pain- 
ful, and will probably come into extensive use. With 
a common lancet, the skin only is punctured. This is 
done by pinching it up between the finger and thumb, 
so as to ensure the safety of the vein. Holding it thus, 
I draw into a small blow pipe, from a drachm phial, 
five or six drops of oil of cloves, and inserting its point 
into the puncture, pass it under the skin, and blow out 
the oil into the cellular tissue, over the most prominent 
part of the veins. In a few days, slight inflammation 
occurs, and the veins become consolidated, by pressure 
on their outsides, caused by the inflammation, to a great- 
er or less degree, thus interrupting their circulation. It 



CURE OF VARICOCELE. HKf 

may be necessary to repeat this once or twice. It pro- 
duces the same result as the others, though not with 
such immediate certainty. It is not so severe as any of 
the other methods. 



CHAPTER XIII. 

CANCER OP THE PENIS. 

There seems to be a remarkable connexion subsist- 
ing between phimosis and cancer of the penis. The 
skilful Mr. Hey, of London, Boyer, and Roux, of Paris, 
all speak of it. Almost every case published by Mr. 
Hey, was thus complicated ; and Roux urges the per- 
formance of the operation for phimosis, in order to pre- 
vent cancer. There is no doubt of the correctness pf 
these observations. I have myself witnessed the same 
complication. 

A small wart or tubercle, on the prepuce or glans, is 
the first evidence of its approach. This will often re- 
main quiet for years, and then, without any apparent 
cause, suddenly enlarge, and soon attain an enormous 
size. The extreme vascularity of the penis, easily ac- 
counts for the rapid growth of any species of fungus, 
that may attack it. 

Warts, as we have said heretofore, grow with great 
rapidity, and excite alarm, from their formidable ap- 
pearance. The patient often imagines them cancerous. 
They are easily distinguished from this affection, by the 
suddenness of their appearance, and the narrow necks 
hat attach them to the parts where they grow. The 
cancerous tubercle has a broad base, the diseased part 



CANCER OF SCROTUM. 201 

merging into the healthy, and evidently proceeds from 
the deeper structure of the penis. It is occasionally 
painful, and the colour is more variable than venereal 
warts. 

Ulcers produced by deformities and constrictions of 
the prepuce,, and ulcers of the glans and prepuce from 
other causes, such as venereal affections, scrofula, me- 
chanical and chemical injuries, &c, must not be con- 
founded with this affection. All these, however, are 
sufficiently marked, in the causes of their access, as well 
as their characteristic appearances, to prevent error, un- 
less in the hands of an empyric. There is but one 
remedy, and that is amputation. It must be early 
adopted, in order to ensure success, and save as much 
of the member as possible. 

Cancer of the scrotum. 
The scrotum, or bag, that contains the testicles, is lia- 
ble to various kinds of tumors, and especially to cancer; 
though this is very uncommon in this country, being 
confined, in a great degree, to chimney sweepers, and 
that too in London; for, strange though it may seem, it 
is almost confined to them. Whether produced by the 
soot, or any other peculiar cause of irritation, it would 
be difficult to determine the actual reason for its appear- 
ance in them. It does not seem to affect the coloured 
chimney sweepers of this city. Nevertheless, we meet 
with it in those of different pursuits here, for I have had 
occasion to excise a portion of the scrotum, in an actu- 
al state of schirrus. It was to all appearance similar 



202 ENLARGEMENTS AND TUMORS. 

to cancer of the lip, having the same granulated struc- 
ture, like a wart on the hand. 

The appearance of these tumors is sufficiently char- 
acteristic. They have the usual hardness, knotty irreg- 
ularity, and occasional pain, as in other cancers, and 
unless early removed, will affect the testicle and cord, 
and the inguinal glands, and then their removal would 
be unavailing. 

Sarcomatous Enlargement of the scrotum. 

This appendage, is also liable to a species of enlarge- 
ment, similar in its nature to the sarcocele of the testi- 
cle. At least it is so in its commencement, for it is un- 
accompanied with pain, or any appearance of maligni- 
ty. It is simply an enlargement. Tt attains, in warm 
climates, the most enormous magnitude. Baron Lar- 
rey describes them as attaining, in Egypt, the weight of 
" one hundred and twenty pounds," and has seen sev- 
eral of this size. In cold climates they never attain ihis 
magnitude. The growth is not supplied with many 
blood-vessels, and is therefore attended with little dan- 
ger to remove, in ordinary cases, or such as may be 
supposed to come under the surgeon's notice, should 
they occur in this latitude. Sometimes these enlarge- 
ments are studded with immense numbers of small 
chalky concretions, such as occur in gout. 

Both of the last described diseases, also affect the ex- 
ternal parts of the female. I have had occasion, also, 
to remove from those parts, several groups of enlarged 
veins, or varices, as they are called by surgeons. En- 
cisted Tumors also form in both sexes, and require re- 



IMPERFORATE VAGINA. 203 

raoval, should their size be troublesome. These occa- 
sionally form within the vagina, and completely hinder 
the performance of the natural functions of the part. I 
have had to remove them, upon one occasion, when 
(their existence was discovered, at a time calculated to 
produce the keenest mortification, viz. shortly after 



Imperforate Vagina. 

This affection is analogous to the congenital malfor- 
mation of the urethra, in the male. Although it gen- 
erally exists at birth, carelessness, and want of atten- 
tion to cleanliness, in mothers and nurses, may cause 
the sides of the mucous membrane of the vagina, sub- 
sequently to adhere at its opening. When it exists 
from birth, it may usually be found directly at the en- 
trance of the vagina, the mucous membrane forming 
a smooth surface, and covering the opening entirely 
up to the urethra, leaving that aperture perfect, or it may 
exist about half an inch deeper. 

The deeper closure is formed by the too close ap- 
proximation of that part of the mucous membrane con 
stituting the hymen. This usually exists in females 
though not always. I have seen this latter conformation 
neglected till the menstrual period, when all the phe- 
nomena of that stage of female life appearing, together 
with increased pain and enlargement from the accumu- 
lating fluid, great apprehensions were excited in the 
parents ; and upon more than one occasion the palpable 
enlargement of the abdomen, has caused unjust sus- 
picions of the chastity of the patient. All the symp- 



204 IMPERFORATE VAGINA. 

toms of pregnancy will occasionally accompany this 
state, and it has continued till the death of the patient 
followed, from constitutional fever, caused by the reten- 
tion of so great a mass of accumulated and decomposed 
fluid. 

I have several times been requested by professional 
friends to visit patients thus circumstanced, and all the 
symptoms have subsided upon incising the membrane. 
On one occasion, more than a quart, by actual measure- 
ment, was liberated from a young woman under the 
care of the late Dr. Churchill, of this city: in this case 
it had been accumulating for three years, the patient 
being eighteen : its absorption through the system, had 
produced the greatest constitutional irritation ; indeed 
actual hectic existed at. the time of the operation. The 
membrane was uncommonly rigid, and more than an 
inch in extent : it had existed from birth, and the oper- 
ation was successful in restoring complete health : al- 
though four years afterwards, on occasion of her first 
confinement, I was obliged to enlarge the vagina by in- 
cision during labour. There have been two subsequent 
accouchements, and no necessity for renewed inter- 
ference. 

The first mentioned obstruction, or that at the en- 
trance of the vagina, is the most common. Dr. Newell 
of New-Brunswick lately requested me to operate on a 
very lovely infant in this city ; the greatest imaginable 
distress existed in the parents, who fancied their child 
was of neither sex: this closure, with a slight enlarge- 

' DC 

ment of the clitoris (a small appendage similar to the 
penis, existing in a greater or less degree in all females) 



IMPERFORATE VAGINA. 205 

having produced the conviction that its title to either sex 
was doubtful. Dr. Newell requested me to relieve theif 
anxiety by an operation, having previously stated to 
them that their child was a female, and explained the 
nature of the deformity. The membrane was incised, 
and a small piece of lint introduced : there was no fur- 
ther apprehension in the parents upon an explanation of 
the operation, and its certain success. These are the 
cases absurdly called hermaphrodites : the intelligent 
reader need hardly be told that the actual structure of 
both sexes, is never united in one individual. 

The Urethra, — or passage for the urine is occa- 
sionally liable to slight obstructions, in new born infants. 
They may be broken through with a probe, and are prob- 
ably little more than mucous agglutination of the parts, 
though their persistence, and the impossibility of passing 
urine during their continuance, demands interference. 

Polypi — are tumours, either of a fibrous or cellular 
character, proceeding by a narrow pedicle from the up- 
per part, or neck of the womb, and occasionally from 
the vagina itself. They sometimes attain a very large 
size, and are attended with most of the symptoms of 
leucorrhea, and irregular and exhausting discharges of 
blood. Although this disease is not common, the author 
has, through the kindness of friends, been called to oper- 
ate in several cases. Two specimens removed by liga- 
ture, with an instrument invented by the author and de- 
scribed at the close of the volume, from patients of Drs. 
Cyrus Weeks of this city, and J. P. Stryker of New- 
town, L. I., are in the cabinet of my distinguished and 
excellent preceptor, Dr. Valentine Mott. 



CHAPTER XIV. 

PROLAPSUS OF THE VAGINA AND WOMB, AND 
LEUCORRHEA. 

Although it is not our intention to introduce organic 
diseases of the womb, we cannot omit with equal pro- 
priety the notice of occasional relaxation of the vagina, 
and its consequence, prolapsus of the womb. By rea- 
son of their great extent and importance, affections of 
the womb itself must constitute a separate treatise, 
though they undoubtedly come under the general division 
of diseases of the sexual organs, and would seem to 
merit equal notice with those of the testicle in this 
treatise. Moreover, many of those who require instruc- 
tion on the subject of diseases of the womb, would be 
unwilling to possess a book treating on affections of both 
sexes. We allude to prolapsus of the vagina, to com- 
plete the sketch of derangements of the sexual passages 
necessary for popular instruction, and the avoidance of 
quackery. A more extended notice of it will be taken 
in a treatise we are now preparing on diseases of the 
womb and its appendages. 

From its peculiar and distensible structure, being de- 
signed by nature as a viaduct for the inception and ex- 
pulsion of the infant, the vagina is susceptible to two 
contiguous causes, calculated to encroach upon its cav- 



PROLAPSUS OF THE VAGINA. 207 

ity, and slight power of resisting pressure against its 
sides. On its superior and anterior part, the distended 
bladder, and immediately above, the womb, with the 
weight of the intestines and pressure of the abdominal 
muscles, is cause enough to account for frequent dis- 
placements from above ; whilst behind and below, the 
frequent distension of the rectum or straight gut, with 
the hardened contents of the bowels and the violent 
straining of stool, is equally efficient in producing the 
same result. 

It was from observing the great prevalence of this af- 
fection, with its frequent consequence, the falling of the 
womb, and the miserable physical infirmity of so many 
of our countrywomen, that the writer devised, some 
thirteen years since, the original contrivance for the sup- 
port of the womb, and abdominal parieties in females. 
This instrument has been the means of incalculable 
benefit to the human family, and under the appropriate 
name of utero-abdominal supporter given it by one of 
its imitators, it may now be purchased of various modi- 
fications and degrees of excellence and price, in most 
of the cities and towns in our country. It was described 
and illustrated by a plate, in the United States Medical 
and Surgical Journal then published by Dr., now Pro- 
fessor Webster of Geneva college, in this state. The 
writer would not have deemed it necessary to substan- 
tiate his claim to this important invention, had he not 
observed a contemptible disposition in some members 
of the profession to plume themselves with borrowed 
feathers : how far the claim is substantiated, depends 
fortunately upon a publication with a specific date ap- 



208 PROLAPSUS OF THE VAGINA AND 

pended thereto. So far as mechanical support will go, 
this instrument will effect all that is desirable ; the in- 
telligent patient, however, always desires radical relief 
if possible ; this can only be attained by raising the 
standard of health. 

The remedies for prolapsus of the vagina, must from 
the variety and complexity of its causes, be various : 
whatever has a tendency to prostrate the powers of the 
body, will by weakening this part in common with the 
rest, allow the encroachment of the bladder and rectum. 
This is rendered very manifest in another complaint, 
usually accompanied with great weakness, which causes 
more extensive prolapsus of the posterior part of the 
vagina than any of the others, viz., dropsy of the abdo- 
men : there is a sack communicating with the general 
cavity of the abdomen, and extending low down behind 
the vagina, which becomes distended with water, and 
often thrusts the posterior wall of the vagina quite 
through its opening, so as to be visible externally to the 
eye. This is not a common cause, however, of that 
state. 

Distension of the bladder will sometimes, from the 
weakness of the anterior wall, permit the complete re- 
troversion of that organ, and its partial appearance with- 
out the external parts, protruding before it the anterior 
wall of the vagina: there is, of course, total suppression 
of urine from the complete reduplication of the urethra 
I have seen this accompanied with periodic expulsive 
pains precisely similar to those of labour, the bladder 
being protruded at intervals like the head of the child ; 
this was but a consequence of the weakening of the 



WOMB, AND LEUCORRHEA. 209 

>agina from leucorrhea. Such a case was described by 
the writer in one of the early numbers of the United 
States Medical and Surgical Journal. 

Child birth, excessive menstruation, leucorrhea, and 
costiveness, are its most general causes ; on the two 
former we shall say nothing, as they do not come with- 
in our purpose. Costiveness may be relieved by chew- 
ing the root of rhubarb ; all other medicines are objec- 
tionable from their too violent and irritating action. 
The monstrous evil of quack pills, so enormously used 
in this country, has produced cases innumerable of fall- 
ing of the womb, piles, prolapsus of the vagina, and 
other diseases. Fruit and vegetables are still better as 
an aperient than rhubarb ; no enlightened person will 
ever use medicine if it can possibly be avoided. Diet is 
the natural remedy, medicine is that of art. A quart or 
two of warm water may be introduced into the rectum 
by means of the improved apparatus for sale at the drug 
shops : it is a good substitute for rhubarb, and may al- 
ternate with it, as the medicine often loses its power if 
too long continued. The next cause of prolapsus of 
the vagina, is productive, through the relaxation of that 
passage, of that scourge of married life, prolapsus uteri, 
by far the most serious complaint of the sex. 

Leucorrhea or whites, is analagous to spermator- 
rhea of the male. See that chapter. It is derived from 
"kzvxos, white, and p«o, to flow. It is a white discharge 
proceeding from the vagina, and sometimes from the 
womb itself. Its causes are fully detailed in the two fol- 
lowing chapters, and we only mention it here, because 
it is a frequent precursor of prolapsus of the vagina and 



210 PROLAPSUS OF THE VAGINA AND 

womb. I would not wish to assert in this book anything 
that would do injustice to the afflicted, but I am obliged 
to say that although it may be produced by excessive 
exhaustion of the powers of life by laborious employ- 
ment, unwholesome air and food, profuse menstruation, 
the use of tea and coffee, and frequent childbirth, it is 
far oftener caused by direct irritation, applied to the 
mucous membrane of the vagina itself. See chapter on 
venereal excess and onanism. There is one observa- 
tion I have often heard made by a close thinking medi- 
cal friend, to which I fully subscribe, viz., that this dis- 
charge sometimes actually takes the place of the men- 
strual secretion, when that is interrupted by wet feet, or 
other causes. 

Many of the symptoms of leucorrhea are occasionally 
identical with gonorrhea, as we have already said when 
treating on that subject ; the reader will remember that 
we advanced the opinion, that gonorrhea in the male 
occasionally originated in this disease, even in virtuous 
and married life. 

The symptoms of gonorrhea however, differ consid- 
erably in the great majority of females from leucorrhea, 
and it is only in very severe cases, where the discharge 
becomes yellow and acrimonious, and reaches the ure- 
thra, so as to produce the distinctive symptoms of gon- 
orrhea, viz., scalding in urinating and inflammation of 
the external parts, that any doubt can exist as to its real 
nature. Should these symptoms with constant dis- 
charge and enlargement of the glands of the groin be 
observed, it is probably gonorrhea. Should the dis- 
charge be irregular, sometimes ceasing entirely, and 



WOMB, AND LEUCORRHEA. 211 

accompanied with no marks of external inflammation, 
and no scalding in urinating, and there exists neither 
irritation, pain, or enlargements in the glands of the 
groin, it is leucorrhea. This distinction must depend 
upon the tact of the practitioner, the character of the pa 
tient, and the symptoms. 

In long continued or violent cases, the discharge as 
sumes every variety of colour and consistence, from 
white to yellow, greenish, and even brown, and varies 
in tenacity, from the thinnest albumen of an egg, to 
gelatinous masses, like the thickest starch. After the 
cessation of the menses, at the forty-fifth or seventh 
year, it is often the precursor of malignant or cancerous 
disease of the uterus. Indeed, it extends, in severe 
cases, to the internal surface of the womb, which, as 
in the urethra and glans of the male, is similar in struc- 
ture, and continuous with the mucous membrane of the 
vagina. These cases can only be discovered and treat- 
ed by the aid of the speculum, an instrument hereafter 
to be described, that exposes to view the entire cavity 
of the vagina, and allows injections to be introduced 
into the womb itself. 

Leucorrhea, from its causes, is peculiar to adult life, 
although children are often affected with transient in- 
flammation of the vagina, from atmospheric and other 
agency. It must be remembered however, that females 
of a very tender age, even as early as twelve years, are, 
from an unfortunate selection of associates, subjected to 
sad examples of vice. The physician must be wary 
and incredulous, should he find a persistent case of 
vaginal discharge in a child. Even in this Christian 



212 PROLAPSUS OF THE VAGINA AND 

city, our court calenders furnish occasional evidence of 
actual gonorrhea, communicated by adult criminals to 
children. In the chapter on onanism, we shall allude 
to the vicious practices and examples of servants and 
schoolmates. 

In addition to the characteristic symptoms of the dis* 
charge, the patient is afflicted with very distressing and 
constant constitutional symptoms, viz. pain in the back 
and loins, great debility, disinclination to movement, fa- 
tigue in ascending stairs, lifting, &c, failure of appe- 
tite, mental depression, chilliness, paleness, and often 
yellowness of skin, and dark circles surrounding the 
eyes. In confirmed cases, there are frequent fainting!, 
palpitation of the heart, and difficulty of breathing, 
swelling of the extremities, with fever, and general pros- 
tration of mind and body. 

In this stage, affections of the womb and dropsy often 
supervene, and unless decisive measures are instituted, 
the patient must succumb. The judicious physician 
will endeavour, in attempting a cure, to restore a natu- 
ral regimen, and to remove as far as possible, all the 
causes tending to prostrate the powers of life. These 
we shall not again allude to, as they may be gathered 
from this and the ensuing chapters. 

The only tonic we shall recommend, is the use of the 
syrup of the iodide of iron. Nothing can exceed its 
happy effect as a tonic, and its use is eagerly continued 
by the patient. Its best results are produced in doses 
from ten, increasing to thirty drops, twice a day. Sea 
air, and, if possible, pleasing society, the shower bath, 
free and constant friction of the skin of the whole body, 



WOMB, AND LEUCORRHEA. 218 

and nutritious and unexciting diet, and the avoidance 
of all stimuli, are indispensable aids to the patient. The 
local use of the cold douche, or a jet of water, playing 
from a bent tube, with some force, against the external 
part, immediately below the vagina, is an admirable 
measure. No purgatives must be taken. Rhubarb is 
to be used, if necessary, for the bowels. The needle 
must be avoided as a pestilence. Its use greatly hind- 
ers respiration, prevents the performance of the health- 
ful play of the heart and lungs, and thus greatly impairs 
the powers of digestion. No tea or coffee should be 
used ; they are pernicious beyond all other things. No 
drink but water, and of that very little. The physician 
will use his judgment in prescribing ale or porter. As 
soon as they can be borne, their effect is good. 

In regard to local means, *I can only say, that in to- 
tally abjuring injections of every kind, I am governed 
by long experience of their utter uselessness, as they 
are recommended in the books, and prescribed for self- 
administration. Though I have spoken of the strong 
analogy between affections of the male urethra and the 
vagina, and it will appear that the means relied on for 
cure, are identical with those used for some affections 
of that passage, still the great difference of capacity 
and construction, renders them quite inert, when used 
of ordinary strength, and with the female syringe in 
common use. 

Although we believe nitrate of silver the best agent in 
use for altering the action of the diseased surface that 
produces the secretion, it is needless to say to the phy- 
sician, that there is no specific efficacy by which it cures. 



214 PROLAPSUS OF THE VAGINA AND 

We only use it because it is a convenient solid stimu- 
lant, that dissolves instantly to a limited and manage- 
able extent, when it touches the part actually diseased. 
Now here lies the difficulty in the use of injections. If 
the syringe in use had sufficient capacity and power to 
distend the whole vagina, it would indeed touch every 
part. But even then, the solution of a scruple to an 
ounce, or even a drachm, would not be half strong 
enough to produce an alterative action. Nothing but 
the pure stick, applied to the entire surface of the dis- 
eased mucous membrane, has, in our hands, produced 
any permanent effect. 

Whoever examines the female syringe, and compares 
it to the structure of the part, and the utter inability 
of the female to apply it properly, even if it were a 
proper instrument, must certainly be convinced of the 
folly of its use. The vagina (in such cases as require 
treatment, a capacious passage) is not only half filled 
and coated with mucus, which instantly alters the chem- 
ical constitution of most if not all the salts in use as al- 
teratives, but its sides lie in close contact, being only 
separated, to a limited extent, during the passage of the 
instrument, in the end of which only there are five 
small holes ! It is very evident that the injection can 
only touch a small surface of the upper part of the vagi- 
na, and immediately subside, in a perfectly inert state, 
to its lower part. The local irritation, attendant upon 
its frequent introduction, I need not say, is highly inju- 
rious ; and when used for leucorrhea caused by onan- 
ism, the astute reader will see, its constant possession 
by the patient, may be attended with other evils, decid- 



WOMB, AND LEUCORRHEA. 215 

wdly subversive of curative intentions. I have known 
this to be the case, for my patient has confessed it 
to me. 

Of injections within the womb, I have only to say, 
that where they seem to be required, by an evident 
continuance of the affection, through its opening, the 
restoration of the vagina to a healthy state, will be fol- 
lowed by cessation of the uterine discharge. This has 
uniformly been the result, in every case, where I was 
able to carry out to a cure, the treatment of the vaginal 
affection. 

In applying the caustic, I have, for the past three 
years, availed myself exclusively of the speculum, in- 
vented by me, and described, with a cut, in Vol. xxx. 
No. 1, of the Boston Medical and Surgical Journal. It 
will fully answer all expectations, when properly made. 
It is applied without the slightest pain, exposing the en- 
tire vagina, at once, to the view, and permitting the ac- 
tion of remedies on every hair's breadth of the lining 
membrane ; advantages that do not appertain to any 
other in use. It has been much approved of by the 
profession, though I regret to say, that the want of at- 
tention of our instrument makers, has quite prevented 
their success. Those in use were made by an ordina- 
ry white-smith, after one manufactured by the writer. 
A cut and description is given at the close of the 
volume. 

A single thorough application of the solid caustic, 
touching lightly every part, until it is whitened by the 
action, will answer for six weeks, and if during that 
period the health can be sufficiently improved, to re- 



218 PROLAPSUS OF THE VAGINA, ETC. 

store the action of the skin, and diffuse the circulation 
it need not be re-applied. 

In relation to the unwillingness of patients to submit 
to the application of the speculum, I can only say, that 
it is for us to cure them, not to remedy an erroneous 
education. An intelligent female, if the physician she 
calls be a well bred gentleman, will never object to any 
measure he may propose for her benefit, providing she 
can be satisfied of its necessity, and this I believe will 
always depend upon his knowledge of the subject and 
the sex, with the possession of that delicacy of deport- 
ment, only the result of a proper education- 



CHAPTER XV. 

SPERMATORRHEA ITS ORIGINAL CAUSES. 

This word is derived from anspfia, semen, and £?«, to 
flow. It therefore signifies a flow of semen, or rather 
a very frequent dribbling. In gleet, the reader will re- 
member, that an appearance of mucus at the orifice of 
the penis, is its peculiar symptom, and we must also 
add, that in enlargement of the prostate, there is a sim- 
ilar appearance. 

The most distinctive characteristic of the seminal dis- 
charge, is its smell, and that will, in all cases, determine 
its nature. Nocturnal emissions, becoming more and 
more frequent, usually precede spermatorrhea ; the lat- 
ter constituting its more advanced and unmanageable 
state. 

When speaking of the anatomy of the lower part of 
She urethra, and the ducts of the prostate gland, we re- 
marked, that on each side of this gland, and lying di- 
rectly on the bladder, there were two small sacks, into 
which the semen was conveyed by the ducts leading 
from the testicle, through the opening in the groin, and 
dipping down each duct, to its own sack. From the 
fore part of each of these receptacles, which are about 
three fingers' breadth in length, and approximate at 
their anterior ends, a single shorter duct, a fingers' 
19 



218 VENEREAL EXCESS. 

breadth in length, passes obliquely, and opens in the 
urethra, side by side, just anterior to the prostate 
gland. This is the point where the semen enters the 
urethra, and it is the relaxation of these ducts, and the 
irritation of the sacks from distension, that causes the 
flow of semen and the nocturnal emissions ; the latter 
being often accompanied with lascivious dreams. 

To complete the anatomical description, immediate- 
ly in front of these ducts, there is an expansion of the 
uretlira, called the bulb, in which the semen accumu- 
lates, previous to emission, in the act of coition. This 
is surrounded with a muscle, which instantly acts, when 
the venereal excitement reaches its acme, and the se- 
men is thereby ejected spasmodically from the urethra. 

We have said, that it is from relaxation of the semi- 
nal ducts that the flow of semen is produced; and the 
reader must distinctly understand, that this relaxation 
implies a loss of contractility, upon the presenceof which 
all ducts and muscular parts depend for their healthy 
action, or that force which causes them to contract their 
openings, and keep in their contents. It is from pre- 
vious excess of irritability and action, that they get into 
this unfortunate state. Now that action occurs, in the 
commencement of spermatorrhea, either frrm excessive 
venery, or from self-indulgence, or onanism. It is, 
therefore, to such excesses, we are to direct our atten- 
tion, in investigating the causes of this disease. 

VENEREAL EXCESS. 

It is not my purpose to deprecate the resentment of 
those worthy men, who, with upturned eyes and up 



VENEREAL EXCESS. 219 

lifted hands, deplore the " pernicious influence" of such 
disclosures upon the "young and rising generation," 
whilst they fix their eyes on some far distant realization 
of spiritual renovation, whose absence they are destined 
so constantly to bewail. We would fain not be misun- 
derstood by those who begin to see the want of some 
active benevolence, founded upon a philosophical view 
of man's real mental and physical nature, disconnected 
from the mass of accumulated error, which has been 
thrown by false moralists, like a funeral pall, over the 
intellect, and smothered all his nobler aspirations. 

It is with the living, moving, present humanity, we 
have to do ; — with a being, who contains within him- 
self the germ of the highest mental and corporeal ex- 
cellence. Alas ! that the web of error, that has so 
assiduously been wound around him, aye, even from 
his earliest existence in his mother's womb, should so 
long have opposed the intent of nature. Thus it was, 
that her own great poet exclaims, in the mouth of Ed- 
mund, in Lear, when he contemplates the miserable in- 
feriority of offspring, so common in those who have 
broken down the energies of the body, by what is called 
"iegai excess," a term to " reason most absurd," and 
contrasts it with his own physical perfection, — 

"Why brand they us 
With base? with baseness? bastardy? base, base? 
Who in the lusty stealth of nature, take 
More composition and fierce quality, 
Than doth, within a dull, stale, tired bed, 
Go to the creating a whole tribe of fops, 
Got 'tween a sleep and wake? " 



220 VENEREAL EXCESS. 

Let us not be misunderstood. We wou d ever re- 
vere and uphold that sacred institution, whose tendencv 
is, ill loving one, to expand the sympathies of our na- 
ture, till they embrace all that belongs to humanity; but 
we deplore the universal ignorance of that great truth, 
that is pointed out by analogy, and every light from the 
ample page of nature, that the intercourse of the sexes, 
could only have been designed for the production of off- 
spring. 

Yes, if man were not begotten in " the dull, stale, 
tired bed," and his education conducted in the laws of 
nature and truth, he would never present himself be- 
fore us in the pitiful condition of the onanist or the lib- 
ertine — his nervous system would never be so early and 
irregularly developed, as to make the whole of his sub- 
sequent life a curse to himself, and full often to present 
him to our view, a drivelling idiot by the road side, the 
wretched occupant of a mad house, or the premature 
victim of consumption. Is this overdrawn ? go to the 
next lunatic asylum, and ask its medical attendant ; — 
ask teachers of all our schools, male and female, super- 
intendents of our houses of refuge, prisons, and colleges, 
the actual extent of the vice of onanism ; — and if liber- 
tinism be the object of your inquiry, live in a city, and 
be answered. 

But why should this be so? Shall man be thus de- 
based for ever? Say rather, why should it not be so ? 
Is he not totally ignorant of the consequences of error? 
does his own nature form any part of his early educa- 
tion ? is he taught to look to the structure of his body, 
for a knowledge of its laws, and does her faithful ex 



VENEREAL EXCESS. 221 

positor — the true teacher — expound them in the schools 1 
or is his early youth spent in the repulsive and dry de- 
tails of the doings of defunct heroes, and mystical hy- 
potheses, alike stultifying to the teacher and the scholar'? 
Judge ye, who visit " our public hives of puerile re- 
sort," and say if the chaste and elegant Cowper was 
not just, when he said, in his review of schools, — 

" Would you your son should be a sot or dunce, 
Lascivious, headstrong', or all these at once, 
Train him in public, with a mob of boys." 

On a previous occasion, when reviewing the causes 
of those distressing female complaints, leucorrhea and 
prolapsus of the womb, with the general physical im- 
perfection of our females, we used the following lan- 
guage, and we are pained to say, we can here add with 
truthfulness, all the additional causes that we are con- 
sidering in the present chapter. 

A prominent place in the list of predisposing causes, 
is due to the defective physical and mental education of 
females in our country, but more especially in New- 
York. The mania that exists for precocious education 
and marriage, causes the years that nature designed for 
corporeal development, and corresponding intellectual 
vigour, to be wasted in the restraints of dress, the school 
and the ball room. With a body not half clothed, nnd 
a mind eagerly intent on pleasure, the hours designed 
for sleep, are perverted by the midnight revel. Une- 
qual effort is required from the delicate votary, to retain 
her situation in school, and thus the evil is perpetuated. 
When one is finished, another in perspective keeps the 
19* 



222 VENEREAL EXECSS. 

mind morbidly sensitive to impression, whilst the con- 
stant restraint of fashionable dress, absolutely forbids 
the exercise indispensable to the attainment of organic 
strength. Exposure to midnight air, and a body reek- 
ing with the effect of excessive dancing, produce their 
legitimate effect, and at last, an early marriage and 
premature confinement, caps the climax of her misery, 
and the unfortunate female, hitherto regardless of the 
plain dictates of unerring nature, becomes an unwilling 
subject for medical treatment. 

It is from such parents, and under such influence, 
that children are born and educated. What wonder, 
then, that their physical and mental conformation 
should present us with its appropriate result, a prema- 
ture exhaustion of the entire system of vegetative and 
intellectual life. And how strange it seems, that any 
one accustomed to ordinary mental effort, and the gen- 
eral analogy of animal life, should not at once perceive, 
that unlimited exactions upon the nervous system and 
sexual organs, is always followed by corresponding 
prostration of the powers of life, and that it must be 
transmitted to posterity. 

Who can say that these excesses are not often fol- 
lowed by those direful diseases, insanity and consump- 
tion ? The records of our mad houses, and the melan- 
choly deaths by consumption, of the newly-married, 
bear ample witness to the truth of such assertions. Are 
they not transmitted to posterity ? Look at the frequent 
mental imbecility, and the pallid hue and attenuated 
form of the children who are the earlier products of 
marriage, and see the parents vibrating between life and 



VENEREAL EXCESS. 223 

the grave, until the candid physician, or the terrors of 
death, teach them to abstain, and nature gathers up her 
shattered powers, and asserts anew her control of the 
organism. Should one lesson suffice and mature age 
be attained, again look at the offspring ; if the first 
children survive, the last would not seem to be born of 
the same parents, so different are they in vigour and 
sprightliness : and in maturer life almost invariably more 
intellectual. 

We have seen in a preceding part of this volume, 
that specific disease is transmitted to the infant within 
the womb, and we know that the physical and mental 
characteristics of parents, are thus entailed on posterity; 
how irrational is it then to suppose, that the actual con- 
dition of the parent, at the time of its procreation and 
gestation, shall not also leave its impress on the vegeta- 
tive existence of the infant. The constant exhaustion 
of nervous energy by unlimited exercise of the sexual 
passions of the parents, will most assuredly seriously af- 
fect its development, and leave its results visible at a 
remote period of its existence. I need not refer to in- 
stances; every mother of several children, if she review 
her general conduct during gestation, will certainly see 
most plainly that those who were born under the most 
quiet state of her system, are blest with the most equally 
balanced powers of mind and body. 

That there is a precocious development of the sex- 
ual desire in some children, does not admit of a doubt, 
and mothers should always be instructed by their physi- 
cians, that the commencement of its unnatural action 



224 VENEREAL EXCESS. 

begins, though perhaps incredible to them, by prolong 
ing the period of its suckling. 

On this point we feel it a duty to explain our views 
at length, as it is undoubtedly the cause of great changes 
in the subsequent life of the infant. Were it necessary 
to advance any other examples of its extreme impres 
sionability to morbid actions on its organism, than one 
already alluded to, viz., the complete rekindling in its 
system the venom of syphilis, when nearly exhausted in 
the parent, and investing it with its most virulent power 
of infection ; we might point to those countless in- 
stances of actual physical changes, brought about by the 
operation of strong mental causes in the mother during 
the earlier periods of gestation ; facts, I cannot forbear 
saying, which prove in their disbelievers an incredulity 
beyond reason. We might do this, yet we fear it would 
be impossible thus to arrest general attention to the actual 
exlcnt of this subject, so full of interest to the observer 
of nature. We shall therefore endeavour to establish 
our proposition, that the commencement of excessive 
sexual excitability may be found in prolonging the period 
of suckling. 

It is conceded by most close observers, that notwith- 
standing the original predisposition to the development 
of temperaments similar to those of the parents, the in- 
fant derives much of its distinctive peculiarity from very 
early impressions ; every new idea of the physical char- 
acters of surrounding bodies, though it will at a more 
advanced age, and by comparison with others already at- 
tained, expand and connect itself with them so as to 
form a train of thought, still it must in the youngest in- 



VENEREAL EXCESS. 225 

fant present itself in a simple state ; a body must be 
hot or coFd, hard or soft. There is no doubt that the 
nervous system, though it cannot refer its acquired 
knowledge to a mind sufficiently matured to determine 
its relations to other and more abstract qualities of ob- 
jects, recognizes the difference of taste, temperature, 
smell, colour, hearing, &c. Very soon, even at two 
years of age in some children, comparison becomes a 
marked exercise of the mind. 

The tendency of all knowledge, derived merely by the 
exercise of the senses in the infant, is to ensure the de 
velopment of the body, and its power of propagating the 
species. To effect this we find at first instinctive 
knowledge, by which the infant seeks and draws the 
milk from its mother's breasts ; this could not be the re- 
sult of education, because it is required instantly to se- 
cure its' end, viz., the continuance of life : it is wisely 
put, as it were, even beyond the power of the will ; in 
short, it is instinct and only instinct. 

Long before the ability to exercise the functions of the 
generative organs, they require an education of their pe- 
culiar nervous system ; composed of what is technically 
called erectile tissue, they are, in common with the fe 
male breast and the lips, evidently under the control of 
mental emotions and associations, at a very early period 
of life ; and as we shall subsequently see, these emotions 
when excessive, lead, long before puberty, to habits 
which sap the very life of their victims ere nature has 
half completed the development of the sexual organs. 

The physician, if inclined to philosophical inquiry, 
will find no difficulty in verifying the premature indica- 



226 VENEREAL EXCESS. 

tion of all the sexual propensities ; repeatedly have I 
listened to the assurances of nurses, and several times 
been a personal witness of the fact, that the approach to 
the breast of the mother was productive of complete tur- 
gid ity of the genital organs ; and I have been assured 
that this at times, was followed by every appearance of 
the nervous exhaustion, attendant on the completion of 
the act of coition : when I say that I have also received 
the assurance that these feelings were reciprocated, and 
often excited designedly by these means, I hope it is 
unnecessary to remark, that such practices could only 
have been resorted to by persons of a truly bestial tem- 
perament. 

Can we say, however, with truth, that nursing is not 
prolonged to favour voluptuous impressions, to a certain 
extent, even in the mother whose mind is comparatively 
pure? I fear not ; professional and general education 
must, however, assume a much higher standard than it 
has yet attained, before this will form a subject of gen- 
eral caution and advice by the medical attendant. I 
hope that we may yet see the day, when the administra- 
tion of medicines and the performance of operations, 
will not form the popular belief of the legitimate extent 
of the medical adviser's duty, but that he will become 
what his title implies, a teacher of wisdom and truth 
from the sacred page of nature. 

It is very evident that these feelings of early prurien- 
cy must have had their origin in a morbid stimulation 
of the nervous system, and it is more than probable that 
a connexion similar in nervous impressionability to the 



VENEREAL EXCESS. 227 

remarkable anatomical similitude, exists between the 
genital organs of both sexes, and the nipple. 

The appearance of the incisor teeth, is undoubtedly 
the indication for withdrawing the child finally from the 
^breast, and it is much to be regretted that any prudent 
mother should require the assurance, that stimulating 
f ood, spices, tea, and coffee, have a great tendency to 
excite the nervous system, and prepare it for the recep- 
tion of that blighting vice that forms the subject of the 
next chapter. 

It will be remembered that we are still speaking of 
the causes of spermatorrhea or seminal weakness: the 
moral treatment necessarily connects itself with and is 
suggested by the causes ; the surgical, as it is equally 
applicable to both, will be considered at the conclusion 
of the chapter on onanism. Thus far we have given a 
general view of those causes, immediately before and 
after birth, which have a tendency to prepare the nerv- 
ous system for sexual excess. We have confined our 
remarks on physical education chiefly to the female, be- 
cause in the next chapter we shall have occasion to 
speak more at length on the early discipline of the male, 
and extend our remarks upon the general conduct of 
more mature life in both sexes ; we do not wish to am- 
plify our subject, though, when contemplating its real 
magnitude and importance, we are conscious of our sad 
inability to treat it correctly. 



CHAPTER XVI. 

ONANISM. 

The word onanism is derived from Onan, a man's 
name ; Genesis, chap, xxxviii, verse ix. The term 
though in common use is not correct, for Onan's crime 
was not self-pollution. See the chapter and verse cited. 
From the remarks on venereal excess and the assump- 
tion of an actual and general physical inferiority in our 
youth of both sexes, advanced in the last chapter, as 
well as the proposition that copulation " could only have 
been designed for the production of offspring," it will 
readily appear that the writer of these pages is not in- 
clined to view this vice as a slight one. When a person 
of the most moderate pretension to the reasoning faculty, 
calmly and soberly reflects upon the actual effect on the 
adult human body of a legitimate indulgence in the ve- 
nt-real act, even in the most healthful and vigorous in- 
dividual, and then fails to see the result that may rea- 
sonably be anticipated by au unlimited practice of the 
vice of onanism, in the bodily and mental development 
of a mere youth, we must suppose an obtuseness of in- 
tellect only to be accounted for by an actual indulgence, 
or a descent from those who have indulged in similar 
vices. 



ONANISM. 229 

Indeed the fact of the predominance of sensual and 
generative ability over the intellectual, in many of our 
race, has given rise to a vulgar adage which it would 
not be seemly to repeat. We beg the reader not to sus- 
pect us of a witticism when speaking on such a subject ; 
we merely designed to remind him of a truth so trite, that 
he has perhaps forgotten its value. 

Let us suppose a person of sufficient intellectual 
power to know his true relation to the mass of living hu- 
manity surrounding him, and their control by emotions 
similar in every respect to his own, whether to the pro- 
duction of good or evil : when such a man, who cannot 
form an undue estimate of his own power of resisting 
vicious impulses, without the friendly aid and co-opera- 
tion of virtuous and refined companionship, contem- 
plates the hopeless condition of the mass of his fellow- 
beings in all that relates to the development of their in- 
tellectual nature, he can only deplore the misdirection 
of philanthropic effort to a remote contingency, rather 
than a certain result, by attention to the actual wants 
of a being having within himself the germ of many great 
and generous emotions. 

Yet, if we look at humanity by the light of physio- 
logical science, we can never shut our eyes to the con- 
viction that the known laws of his physical and moral 
being, when they form a subject of constant violation 
from the cradle to the grave, would, if one-half the at- 
tention were paid to their correct observance, elevate 
his spiritual nature far beyond the conception of the 
visionary enthusiasts, who are so constantly deprecating 
his lost and fallen condition. All society proves the 
20 



230 ONANISM. 

truth of our assertion ; wherever the genial emotions of 
the soul are shut out by the severer regulations of ascet- 
icism, there will ever and anon appear some flagrant in- 
stance of vice, the result of smothered passion. 

I need not point the reader to the long catalogue of 
crime, the consequence of monkish and fanatical insti- 
tutions, nor yet direct his view to the shameless conduct 
of the false moralists of the present day, who would pre- 
tend to have us believe that the most innocent amuse- 
ments of youth are a certain preparation for future crime. 
To the physiologist, who can only see the intent of na- 
ture through the written page of her living organism, 
the horse hair shirt and the fasts of the eremite, and the 
deprivation of every natural diversion by the fanatic, are 
equally available as a means of elevating the character 
and improving the mind of our species. He feels and 
knows, by virtue of that sublime and lofty science which 
has led him humbly and reverently to the footstool of his 
great teacher, that her laws are written indelibly upon 
every living blade of grass, every insect and animal ever 
moulded by her plastic hand, and are not to be disobey- 
ed but with the certain result of impairing her handy 
work, and impeding her progress to the great end pro- 
posed, viz., the production of a perfect human being, 
with his intellectual and physical powers equally devel- 
oped. Such was the original intent of nature : it would 
be unphilosophical to believe otherwise. What then has 
prevented the attainment of this great end in so large a 
proportion of our species ? those who are fond of mysti- 
cal hypotheses may form their own answer; we are 



ONANISM. 231 

content to believe it the consequence of a disregard of 
her laws. 

In the preceding chapter we have endeavoured brief- 
ly to show the influence of excessive venery in the pa- 
rents, in the development of morbid propensities in the 
offspring ; we now design to trace the evil to those re- 
sults in which the child acts a voluntary part, and to 
show how this unfortunate vice is favoured by erroneous 
education and regimen, until all the energies of the mind 
and body are quenched within him, the brightness of 
day becomes like the blackest night, and he looks to the 
grave as the only refuge from despair. School is the 
place where the first, lessons of the onanist are taken : 
at first the tender years of the child prevent the exist- 
ence of any shame in the act, and he often practises it 
as a matter of emulation with his associates ; the unfor- 
tunate obtuseness of too many teachers prevents the dis- 
covery, and if detected, a want of knowledge of its con- 
sequences causes little effort to correct the vice. 

We have been asked by parents at what age this 
wretched habit commenced, and often have thought of 
the expressive language of that immortal man, who has 
carried it to its utmost extent in conveying the hidden 
emotions of our nature. 

" The canker galls the infants of the spring - , 
Too oft before their buttons be disclosed ; 
And in the morn and liquid dew of youth, 
Contagious blastments are most imminent. 
Be wary then ; but safety lies in fear ; 
Youth to itself rebels, though none else near." 



232 ONANISM. 

As early as eight years, we are satisfied of the exis- 
tence of such habits. The vegetative powers of life are 
so strong, as to conceal the evil effects upon the organ- 
ism, but in a few years the pallid hue, lack-lustre eye, 
and emaciated form, and the impossibility of applica- 
tion to mental effort, show its baneful influence. As 
puberty approaches, the passion increases from what 
has so Jong stimulated its morbid appetency, and it soon 
becomes evident to the observer, that some powerfully 
depressing influence is checking the development of 
the body. Consumption is talked of, and perhaps 
the youth is removed from school and sent into the 
country. 

This is one of the worst possible movements. Re- 
moved from the ordinary diversion of the ever-changing 
objects of the city, and the powers of the body too much 
enfeebled to give zest to the healthful exercises of rural 
life, he turns his thoughts inward upon himself, and is 
at once in a still stronger grasp of his besetting sin. Still 
the danger is unsuspected. 

If the patient be a female, the approach of the 
menses is looked for with anxiety, as the first great 
epoch in which nature is to show her saving power in 
diffusing the circulation, and visiting the cheek with the 
bloom of health. Alas ! " Increase of appetite has 
grown by what it fed on," and the energies of the sys- 
tem are so prostrated, that the whole economy is de- 
ranged. That beautiful and wonderful change, in which 
both mind and body undergoes so fascinating a trans- 
formation, from the child to the woman, is looked for in 



ONANISM. 233 

vain ; the parents* heart bleeds with anxiety, and fan- 
cies the grave but waking for its victim. 

Should some thoughtful physician now chance to be 
called, he will probably find an entire freedom from all 
serious or organic change, in any of the contents of the 
three great cavities of the body, but the greatest de- 
rangement in the functions of all the organs. Universal 
lassitude of the muscular system, unrefreshed by sleep, 
irregular and often enormous appetite, with dyspeptic 
symptoms, acceleration of the pulse, with hot hands and 
flushing of the body, dryness of the skin, pallid coun- 
tenance, and eruptions of the face, pain in the back, 
often spasmodic and violent, slimy thick deposit, and 
high colour in the urine, great dryness and heaviness 
of the eyelids, which are tinged with red and blue un- 
derneath, frequent black spots flying before the eyes, 
with temporary suffusion and loss of sight, loss of mem- 
ory and want of attention, great mobility and restless- 
ness, constantly changing the position and employment, 
lascivious thoughts, with a horror of female society, or 
male, according to the sex of the patient. 

To these symptoms, may be added nocturnal emis- 
sions of semen, and soon a constant flow of mucus, 
mixed with semen, with loss of the power of erec- 
tion. Fatuity and epileptic fits often close the scene, 
in one of which the patient may expire. During 
the superintendence of Dr. Wilson at the Blooming- 
dale Asylum, this sad result occurred to two of the 
writer's patients : — reason had for some time left them, 
and both died in an attack of epilepsy. They were of 
both sexes, and about twenty years of age. 
20* 



334 ONANISM. 

There is an indefinable expression about the eyes 
and general manner of $uch patients, that at once ad- 
dresses itself to the attention of those who study the 
physiognomy of disease. They are restless, and often 
averted from the person he is addressing. The pupils 
are dilated. There is no earnestness, " no specula- 
tion" in them; no repose of maimer, but a hurried ad- 
dress, as though frightened, and a rapid transition from 
one question to another : — these persons question only, 
they rarely converse. The mind is incapable of connect- 
ed effort, and intent on nothing but lasciviousness, or 
sad forebodings of its unhappy state. 

If compelled to mingle with company, the manner is 
evidently constrained, and impatient of particular atten- 
tion. They seem aware of their peculiarities, and ap- 
prehensive of discovery. Nothing is more desirable to 
them than solitude, and yet nothing they more dread, 
for fear of themselves. In public institutions, where 
large numbers of children are assembled, it is easy to 
point out those afflicted with onanism. 

If at a school, where the disgusting and brutal sys- 
tem of corporeal chastisement is followed, the aspect of 
the poor child is quite pitiable. Utter inability to com- 
mit his tasks, together with an assurance of the inevita- 
ble consequence, adds a very painful appearance of ap- 
prehensive solicitude and constant tremulousness, to the 
characteristic symptoms of the disease, that painfully 
indicates to the observer the entire state of the case. 

In prisons, this is also still more apparent ; for there 
is added, in the adult criminal, the brutal obtusenesn 
*nd despair consequent on long detected crime. 



ONANISM. 235 

In colleges, the student presents an aspect of moody 
and abstracted melancholy. The mind too cultivated 
to be ignorant of the causes of its distraction from con- 
nected effort, is nevertheless too feeble to resist the fiend 
that besets it, and there is an apparent conflict of the 
more exalted and baser emotions, very painful to behold. 

In lunatic asylums, the most melancholy exhibition 
of the results of the vice appears. The countenance is 
actually sodden and quite destitute of expression. 
Neither mirth nor grief ever visits it. The body is in- 
active for days together. They may often be seen on 
their knees for hours, gazing on vacancy, with their 
hands strapped behind them, to prevent open commis- 
sion of the vice. Should a sound of the voice occur, it 
is rarely articulate, and we are reminded forcibly of Col- 
lins' expressive description — 

" With woful measures wan despair, 
Low, sullen sounds — his grief beguiled." 

Epileptic and convulsive attacks occasionally vary this 
mournful exhibition, in one of which the patient may 
expire. 

Yet it is difficult to trace the appearance of the sad 
habit, where it produces a more distressing influence 
upon the mind, than in a female boarding school. All 
the solicitude of the physician is awakened, and he be- 
comes conscious of the wide difference between frivo- 
lous accomplishment and mercenary coldness, and the 
happy influence of parental and domestic education. 
In young girls, the difference between those whose fac- 
ulties are crippled by onanism, and their companions, 



236 ONANISM. 

is extremely apparent. The accomplishments of music 
and dancing, are from their very nature so opposite in 
their requisitions upon the mind and body, to that state 
of general lassitude, the inevitable result of this vice, as 
to present a powerful contrast between the employment 
and pupil. 

As to the extent of this habit, I am thoroughly satis- 
fied that if its actual prevalence were known to parents, 
they would rather their children should grow up in igno- 
rance, than subject them to such sad influences, as are 
too often found in boarding and day schools. This 
must ever exist, until teachers themselves are properly 
educated, and parents are willing to retrench vulgai 
luxuries, in order to afford competent intellectual and 
physical culture to limited numbers of children, in 
place of the "young ladies' seminaries," &c, of the 
present day. 

We do not design to write an essay on ethics, but it 
is part of our subject to show how the original tendency 
to excessive nervous excitability, impressed upon the 
child by the constitutional errors of the parent, may be, 
in some measure counteracted, by an education, found- 
ed upon the never-changing laws of his animal and 
mental nature, or, in other words, upon true phy- 
siology. 

If we had the power of Combe, or Isaac Taylor, we 
should feel some ability to impress the mind of the read- 
er, with the conviction of radical error in our whole sys- 
tem of education. We have already termed it a ma- 
nia, and given a slight hint, when speaking on venereal 
excess during gestation, and the errors of long suckling* 



ONANISM. 237 

of its morbid stimulation of the nervous system, and 
shown how it leads to the vice of which we are treating, 
or insures an early death, by some of the numerous ills 
of youthful life, under the denomination of scrofula. 

We would not convey the idea, that all scrofulous 
children are guilty of this vice, for it is often otherwise; 
but we are strongly impressed with the conviction, that 
venereal excess or onanism in the parent, with the con- 
stant and increasing desire for youthful precocity, is the 
actual root of tubercular or scrofulous phthisis, or con- 
sumption. 

It certainly was the intention of nature, to form a be- 
ing that should attain maturity : and as this intention is 
often rendered abortive, where fortune, and all the other 
aids of civilization and parental affection, conjoin to its 
attainment, there must be some error, of great and con- 
suming power, to account for the constant failures in 
the attainment of her end. Does it seem then, on a 
first glance, unphilosophical to select that passion, which 
is acknowledged to be the strongest in its action, and 
the most depressing in its influence, of all others be- 
longing to our nature, as a probable agent in producing 
organic and fatal changes in the human body 1 and should 
we find that the whole system of youthful training is cal- 
culated to foster such propensities, will it not be a legiti- 
mate inference that the true method of amending the 
evil will be to alter the system 1 

The self complacency and ignorance of most parents 
will generally prevent anything like an acknowledg- 
ment of error to their family attendant, should he be in- 
telligent or independent* enough to point it out. The 



238 ONANISM. 

utmost extent of their reasoning is, that such suggestions 
were quite unknown when they were children, and yet 
they survived ; it would be too severe a tax upon their 
self-love to ask these parents in what condition they sur- 
vived. It is quite probable they present many personal 
indications of erroneous education in their parents and 
themselves; probably at middle life destitute of hair and 
teeth, and tremulous with nervous agitation, they are 
unable to undergo ordinary mental or bodily exertion, 
and form wretched examples and miserable protectors 
to their offspring. Yet these people are perfectly willing 
to assume all the responsibility of their children's train- 
ing. 

The first great error in the development of the nerv- 
ous system after the child is taken from the breast, con- 
sists in loading it with sweltering and ill made clothes, 
and putting it to sleep upon a feather bed : a constant 
and unnatural degree of heat is thus kept up, and that 
of all other causes has a tendency to foster morbid sensi- 
bility. Should there be two or more children, they are 
often placed in one bed ; this, besides producing in 
summer excessive heat, often induces them to exhaust 
each other by tickling ; a most pernicious custom, and 
one in which all children indulge : besides, it overcomes 
a wholesome feeling of independence which they feel 
when they can be alone in the dark without fear of 
hobgoblins. 

The custom of telling them ghost stories it can hajjj 
iy be necessary to reprobate ; none but the most pitia- 
bly ignorant persons could possibly allow it. It has, 
however, of all other causes, the greatest tendency to 



ONANISM. 239 

excite and exhaust the nerves. Tea and coffee, with 
much butter or greasy diet, has a pernicious influence, 
and should never be allowed children. Milk, eggs, bread, 
and sugar, is their proper nourishment, and moderate 
quantities of animal food. This should never be de- 
nied to scrofulous children particularly. Farinaceous 
diet they must have to the full extent they desire, and 
ripe fruit during the summer. Cold and shower baths, 
under competent medical advice, have a charming in- 
fluence in developing a good nervous system. We 
consider this treatment to embody the intention of na- 
ture. The errors just enumerated are to be avoided — 
above all other things, excessive warmth of clothing 
and bedding, are to be carefully shunned.* 

School is out of the question till the sixth year ; and 
if there should be any predisposition to unusual deli- 
cacy, the eighth is quite early enough, and then never 
over an hour's attention at one time should be exacted. 
After the eighth year, the imaginative faculty largely 
assists the early errors of education ; and domestics and 
larger companions, by obscene conversation, and prints, 
soon poison the mind, and it is shocking to know, often 
by direct attempts upon the person, communicate a full 
knowledge of the vice. 

Our whole system of domestic aid is so wretchedly 
managed, that it is sickening to the heart of every in- 

* Will the reader believe that the barbarous corset, that instrument 
of cruelty and ignorance that would put a flat head Indian to the blush, 
is sometimes applied to children of eight years by American mothers ? 
Alas ! it is too true, and the law for preventing " cruelty to animals " 
is not enforced. 



240 



ONANISM. 



telligent mother to reflect upon the inevitable effect of 
such example upon the minds of her children. If no 
actual vice of the kind we are considering exist, still 
there is always an extensive influence on the character, 
tending to the development of the lower and animal 
emotions. Excessive dress, and general coarseness, 
and vulgarity of expression and appearance, have a 
constant effect in shutting out habits of a simple and 
natural refinement, of attire and expression, and that 
quiet manner that is so characteristic of good breeding 
and correct example at home. 

In families where much society is kept, there is often 
a carelessness of expression in presence of children, and 
an injudicious notice of them by our sex, that can soon 
be traced in their actions and deportment, and thus we 
often find habits originating, of a character evidently 
tending to sexual precocity. I have heard children of 
a very tender age express great desire for the develop- 
ment of the breast, and actually allege, in language not 
to be mistaken, that they knew it to be agreeable to 
gentlemen. 

The " canker galls the infant of the spring," indeed 
full early in our " rapid country ;" and we are fairly 
open to the censure of intelligent foreign observers for 
our insane love of precocious development in children. 
The passionate adulation of doting mothers, and ill- 
judged praises of our own sex for some premature im- 
pertinency of their mismanaged, or rather unmanage- 
able, offspring, I have often seen elicit the smile of 
pity from the thoughtful physician. But we must cease ; 
it is not pleasant to trace such weaknesses, nor have 



ONANISM. 24 1 

we the space to occupy with their detail. When the 
patient presents himself before us, it is our business to 
benefit him, if possible. 

I need not say, where the treatment depends as much 
upon moral means as on surgical and dietetical efforts, 
perfect candour should be used. The physician, how- 
ever, if at all acquainted with human nature, can very 
often suffer the patient to infer his comprehensive know- 
ledge of his case, without charging him in the beginning 
with all his folly. Such a course should never be taken 
unless in cases where ignorance demands intimidation. 
In a great number of cases of both sexes, and in almost 
every condition and occupation in life, I have found no 
class of diseases that required a greater amount of sa- 
gacity, sympathy, and firmness, than in those involving 
these habits, and a suspected loss of virility. 

In the remarks made on gleet, I have given the only 
reason I am willing to entertain for the extreme anxiety 
on this subject ; yet I must say, that a large portion of 
such patients, seem to be influenced only by the more 
sensual estimate of their powers. Let us hope that the 
happy influence of philosophy, in improving the con- 
dition of the species, will ere long, teach them the beauty 
of humanity, when all its physical and moral develop- 
ments blend in harmonious proportions ; then they will 
view the gift of virility only as the union of their own 
identity with ages yet to come, in which their offspring 
may fulfil the entire purpose of their creation. 

We must, however, come down to the living reality, 
and if we would serve our patient and win his confi- 
dence, approach him with a manner adapted to his 
21 



242 ONANISM. 

actual nature. It is the sententious gravity of many of 
our profession that repels the patient and prevents his 
showing confidence ; he does not believe that such fri- 
gidity of exterior can cover any warmth of feeling and 
interest in his case ; — shall we say that he looks for a little 
more evidence of the possession of actual knowledge? it 
is often so, if we are to believe the assurance of the pa- 
tient ; when he feels that he is actually benefitting by 
our prescription, he will express great surprise that his 
disease was not discovered by the practitioner whom he 
had previously consulted ; yet it oftener happens that he 
seeks the aid of a surgeon from mere bodily exhaustion, 
and seems scarcely conscious of the influence of his 
habit upon the constitution. 

In far the majority of such cases, it is left for the sur- 
geon to discover and inform him of the true nature of 
his case. This he should do in a manner evincing 
sufficient sympathy to interest the patient in his advice : 
should it be discovered upon a proper series of ques- 
tions concerning the symptoms, that the mind is much 
affected, and the patient be naturally of a low order of 
intellect, the most judicious manner of proceeding may 
be at once to excite his fears for his safety. 

If the surgeon perceive a decided unwillingness 
to confide his secret, and on a review of the symptoms 
and general physiognomy of the case there remains no 
doubt of the habit, he will do well after having assured 
the patient of his real danger, to inform him that he will 
prescribe upon the conviction of the existence of loss of 
tone in the seminal ducts, produced by excess of vene- 



ONANISM. 243 

real desires; letting the patient infer his entire know- 
ledge of the habits, till entire confidence is produced. 

If the prescription is followed, there will be little doubt 
of the fact ; and this course will produce a correct un- 
derstanding between them in the beginning ; the patient 
will admire the acumen and delicacy of the surgeon, 
and resolve to obey him. Nothing can be more difficult 
than to convince him of the extent and power of the 
causes that have produced his propensity, and their 
intimate connexion with the symptoms to be treated. 
He cannot be made sensible unless of a decidedly intel- 
lectual character, of the power of those errors in his 
early education which still operate upon his nervous 
system, and require all his efforts to break up their mor- 
bid association. Hence it is that we are often compel- 
led to appeal to his fears, and to assure him that our 
treatment can only avail in preserving his life, by his 
yielding implicit obedience to all our requisitions. 

The first must be to discontinue the habit ; if onanism, 
at once and for ever ; if excessive venery, also total ab- 
stinence for a time, only to be resumed at the advice of 
the surgeon. This cannot be done by an effort of the 
will alone, for self control has long since been abandoned. 
Moral and medical means must be united if we hope 
for success ; all gloomy associations must be broken up ; 
cheerful society of both sexes and constant and agreea- 
ble employment, not taxing the muscular powers of at- 
tention too largely, must be prescribed ; gardening, bil- 
liards, the lighter mechanics, &c, free exercise in the 
open air, riding on horseback, the application of cold 
water three or four times daily to the private parts, and 



244 ONANISM. 

between them and the anus particularly, or the cold 
douche as recommended for leucorrhea, are admirable 
and indispensable agents in diffusing the nervous excite- 
ment and arterial circulation, and preventing the accu- 
mulation of morbid currents at the genital organs, and 
their re-action on the mind with the impulse to onanism. 
When in bed, the patient should lie on his belly ; noc- 
turnal emissions almost always occur when lying on the 
back. 

Nothing can be done without local applications of 
cold water, and free exercise ; the bowels must never 
be constipated ; fruit is the best aperient ; no medicine, 
but, if needful, rhubarb may be used. Solitude and heat 
are the greatest inducements to onanism ; hence the pa- 
tient should arise the moment he awakes, and stand 
naked on the cold floor. Tea and coffee, with spices and 
much greasy diet, operate most decidedly on the nervous 
system, and secondarily on the genital organs: this is 
the explanation ; whatever excites the nervous system 
excessively, not only adds to pre-existing irritation of the 
genital organs, but induces a morbid desire for a vent, 
and that unfortunately for the poor patient is too easily 
attainable. It is this facility of procuring his customary 
excitement that renders onanism so much more exhaust- 
ing than venery ; it can always be indulged in : doubt- 
less the depressing influence is aided by a conviction of 
the unmanliness of the act ; nay, we know this to be so, 
by the necessity we are under, in the morbid doubts of 
their virility often existing in onanists, to recommend 
marriage as the only curative measure in many instan- 



ONANISM. 245 

ces. The horror of female society also proves this, fa; 
the libertine, unlike the onanist, seeks it. 

If it were possible for the enlightened physician to in- 
duce a rational system of education, he might render the 
most efficient aid in checking this loathsome vice, by dif- 
fusing the pleasureable emotions of youthful life in a 
more equal manner, and varying the repulsive detail of 
labour or school by well selected and instructive amuse- 
ments : music, the principles of mechanics and the sci- 
ences, particularly chemistry and anatomy, gymnastics, 
experimental agriculture, declamation, &c, are all most 
efficient aids, and such as cause the philanthropist to sigh 
when he thinks how attainable they are, and how com- 
pletely they might take the place of the present wretched 
system, and all be fully carried out, even in our public 
schools, if legislators were but enlightened. 

What a startling fact is presented to our view in an 
adjoining state, where the system of public education is 
acknowledged to be in the lowest condition, and the sta- 
tistics of insanity show a numerical extent, with a single 
exception, equal to any portion of the globe containing 
a similar number of inhabitants. Ask any enlightened 
physician the principal causes of insanity in an agricul- 
tural district, and he will tell you fanaticism, onanism, 
bad diet, and repulsive and monotonous employment, 
and these every one knows are favoured by ignorance 
of the true laws of our nature. There is in our climate 
a remarkable want of circulation in the skin, and a 
marked increase of nervous excitability, that does not 
exist in their English ancestors : the consequent fre- 
quency of the depressing emotions, and the absolute 
21* 



246 ONANISM. 

abandonment of popular amusements in the agricultural 
districts, with the immoderate use of tea and coffee, to- 
bacco, and too often liquor, has proved almost too much 
for poor humanity. 

The extent and elegance of our lunatic asylums is a 
wretched subject for boasting ; the expense were far 
better applied to the public schools. We speak from 
extensive experience, when we assert that this habit is 
almost universal in public institutions, and is utterly un- 
suspected in most instances by their supervisors. They 
have fixed an artificial standard of requisition upon the 
powers of mind and body of their inmates, and nature 
will not yield to it ; variety is necessary in all the pur- 
suits of humanity whether of the child or the philoso- 
pher : even the adult was never intended to pursue any 
employment intently for more than two or three hours. 
Not only the individual set of muscles used, but the 
organs of the brain controlling the movements become 
exhausted, and demand the recuperative effect of change. 

The onanist resorts to the most available means of ex- 
citement : he has been confined to the repulsive and ex- 
hausting details of school or labour, and he seeks the ut- 
most concentration of its opposite, viz., pleasurable emo- 
tion. The well-known sympathy of the affections of 
mucous membranes, admits us to the secret of the power 
of venereal excess in producing bronchitis in many indi- 
viduals, whose pursuits do not admit of their indulgence 
in the innocent recreations they are accustomed to call 
sinful. Their appetite for pleasure becomes morbid from 
unnatural deprivation, and they seek it, as theo'ertasked 
school boy flies from school and the rod to the play- 



ONANISM. 247 

ground. But onanism is not confined to children and 
youth by any means : occasionally, men of every age 
and variety of pursuit, literary and mechanical, are 
known to be its victims by every practitioner of intellect 
and experience. The writer, had he been inclined to 
betray confidence, might have preserved dozens of let- 
ters from every part of the country, conveying the most 
moving and graphic pictures of distress from long aban- 
donment to the vice. 

So far we have spoken of the constitutional remedies 
for excess of venery, as well as onanism : they are ad- 
dressed to the mind and body generally with the excep- 
tion of the local application of cold ; a measure we be- 
lieve to comprise all that can be done in the way of di- 
rect application, without the immediate agency of the 
surgeon : it is fortunate that its action is so eomprehen- 
sive, for it will doubtless effect, in most cases, in con- 
nexion with the general regimen and entire discontin- 
uance of the habit, a complete cure, or at any rate suffi- 
ciently invigorate his constitution to make marriage, (if 
the patient is an onanist) advisable. 

That is the most certain method of interrupting the 
morbid desire ; and is always advised by the intelligent 
surgeon as soon as the constitution can be sufficiently 
restored. An entire cessation of the spermatorrhea 
need not in all cases be anticipated, for the excess- 
ive exactions so long made upon the seminal secre- 
tion, has caused an unnatural activity, and often an 
excessive production : this with the morbid conviction 
of loss of virility, and the moral necessity of a total aban- 
donment of the vice compels the surgeon to advise mat- 



248 SURGICAL TREATMENT 

rimony when the patient fancies himself unfit. To the 
intelligent this may be explained ; those who are not so 
must trust their surgeon. 

The thousand advertised nostrums of the day, such 
as invigorating, procreative, lucina and other cordials, 
are all most infamous deceptions, designed to gull the 
credulous, and to excite the jaded appetite of the liber- 
tine. These medicines are of course all taken from the 
pharmacopeia of the physician, and I am sorry to say 
that an erroneous opinion of their action, has prompted 
their occasional prescription by well-meaning and in- 
telligent men. A more acute and thorough investiga- 
tion of their action, has satisfied the physician that they 
can only operate as they do in gonorrhea ; i. e., gener- 
ally, on the entire mucous membrane of the bladder and 
penis; hence their highly injurious action must be ap- 
parent, for there has already been excessive stimulation, 
and the parts want rest and invigoration. 

We repeat it then, no medicines will ever be given 
by the enlightened surgeon, by the mouth, for the pur- 
pose of controlling by their specific action spermator- 
rhea or the involuntary seminal discharge. As in leu- 
corrhea we often resort to tonics for their general action 
on the system, and their secondary and local reaction on 
the relaxed and irritable seminal ducts, with the happi- 
est effect ; but we use general and tonic agents, noi 
stimulant and specific. 

The only local means to be used by the surgeon, is 
that devised by Mons. Lallemand, a distinguished French 
surgeon ; the application of nitrate of silver to the mouths 
of the seminal ducts. This admirable suggestion is pre- 



OF SPERMATORRHEA 249 

cisely analogous in its intention and action, to its use in 
leucorrhea ; it is done to alter the action, i. e., to re- 
store the contractility of the mouths of these ducts, which 
by their relaxation, permits the semen constantly to 
flow into the urethra, from the two receptacles at the 
base of the bladder, as described in page 218. There 
are some very important cautions and suggestions to be 
made in relation to this remedy, upon which we con- 
ceive its efficiency as a curative agent will entirely de- 
pend. They relate to the proper cases for its applica- 
tion, and its frequency. 

We premise, and refer to what we have said when 
speaking of spermatorrhea caused by venereal^excess, 
page 227, that this remedy is applicable to both, when 
the semen flows away, either without the power of erec- 
tion, or when it exists to a limited extent. It is far 
oftener required in cases of onanism, by reason of the 
greater frequency and extent of spermatorrhea from the 
latter cause. Moreover, we shall find when persons ap- 
ply to us for aid, who have been addicted to venereal 
excess, a totally different conformation of mind and tem- 
perament ; there is a union of the imaginative and physi- 
cal or nervous power, that the confirmed onanist never 
possesses ; the debauchee has an activity of mind and 
body that keeps up to the last, and renders him a far 
less suitable subject for a stimulating local remedy, than 
the onanist, who is supposed, if so far advanced as to 
confide his troubles to a surgeon, to be completely wilt- 
ed down in mind and body. To the former we shall do 
better to preser.t moral and constitutional remedies to 
restrain his propensities, whilst to the latter we may be 



250 SURGICAL TREATMENT 

compelled to address local means, to shut up the sources 
whence his very existence is draining from him, till we 
have time to address other remedies with any prospect 
of success. 

The former, as well as the onanist, in the early stage 
of his troubles, is supposed to have the power of erec- 
tion ; and if they do not produce emission by voluntary 
stimulation, they are incited thereto by dreams, or men- 
tal and lascivious oauses, even when awake ; this then, 
is the excess of irritability we spoke of; to such cases 
caustic should never be applied ; the treatment is con- 
stitutional entirely with the exception of cold, which is 
equallv.applicable to them both. 

I know that caustic has been applied as in stricture, 
to overcome excess of irritability, but that is loose reason- 
ing and an erroneous conclusion. The morbid state is 
in the mind, and the irritability in the seminal recepta- 
cles, from too constant distension owing to increased 
secretion of semen, from the excessive demands upon 
the testicles, that produce it. In stricture, the spasm 
produced by muscular irritability, is caused by actual 
morbid alteration in the structure, and the stimulus is 
the urine, or the surgeon's bougie ; the mind has noth- 
ing to do with it. This application of caustic to active 
or as surgeons call it, entonic spermatorrhea, is totally 
erroneous and can do nothing but mischief. 

Its use must be confined to the passive or atonic state, 
in which the semen runs away without erection, or with 
a very partial and momentary degree of it, and without 
dreams or voluntary means for producing its emission 



OF SPERMATORRHEA. 251 

m short the patient must present the ultimate symptoms 
as already detailed. 

Again I must crave pardon for serious objections as 
it regards the frequency of its application, even in the 
hands of surgeons for whose abilities I have the highest 
regard. Remedies never act in a similar manner on 
any two individuals, but more especially in diseases 
where the mind has a degree of control so supreme as 
in those of the genital organs. The same cautions are 
necessary as in the treatment of syphilis and gonorrhea. 
A person o frelaxed fibre and scrofulous temperament, 
may very soon get his seminal ducts in a passive state, 
and present every symptom of the onanist of many years. 
Of course there must be great original difference in the 
contractility of these parts, and they cannot be equally 
susceptible to remedies: there is no possibility of form- 
ing a correct judgment, without closer oservation of the 
effect of the remedy in every case : X should never be 
reapplied until its effect is decidedly d creasing. I have 
repeatedly been obliged to apply it < ;ice only in a fort- 
night and even a month : for by its more frequent ap- 
plication in the same case, I have been satisfied that I 
had produced increased irritation of the seminal recepta- 
cles themselves, though they are some distance from the 
mouths of their ducts, where it w..s applied. 

The surgeon may also expect often to be disappoint- 
ed in the action of the remedy for two or three days, 
and then see its palpable benefit for an entire fortnight ; 
there may even be decided power of erection, especially 
if cold water is freely used to the part, and the shower 
bath and other invigorating treatment adopted at the 



252 SURGICAL TREATMENT 

same time. All the regimen previously directed must 
be fully carried out, and the surgeon must constantly 
suspect the patient of a continuance of his habit, and 
give him emphatically to understand, that by no possi- 
ble means can he benefit if he be not faithful in abstain 
ing even in mind as well as act. Tell him when the 
fiend approaches, to flee at once out into the open air, 
and divert his attention by change of objects and asso- 
ciation : if in the morning and in bed, to arise instantly 
and stand on the cold floor and use freely the cold hip 
bath, cold applications, or the douche : to sing, to de- 
claim, to dance, anything to divert the mind from its 
morbid state. 

But above all other things, let him force himself as 
soon as possible, to esteem the society of virtuous and 
refined females; true, he has lost the habit of yielding 
those thousand nameless attentions, and that implied 
deference of manner so winning to the female heart ; 
he can no longer converse with calmness and dignity, 
and inspire respect for his attainments ; his eye has lost 
its brightness and his frame its strength, yet all these 
may return under the genial influence of health and so 
cicty, and a calm but determined resolution, with the 
aid of his faithful surgeon to be a man again. Ther 
will the brightness of the eye, and elasticity of step re 
turn to him ; memory too will open her magic store, 
and the hue of health will revisit his cheek : instead of 
the vacillating purpose and constant mobility of body 
and mind, the fitful startings or heavy stupor of the 
night, quiet dignity of manner, and the calm sleep of the 
infant, will add gracefulness and life to his action, and 



OF SPERMATORRHEA. 253 

the approving glance of the sex will cause him to look 
back with norror upon those years in which he forgot 
to respect his true manhood. 

The amount of nitrate of silver to be used at one 
time should never exceed the bulk of a grain of wheal, 
which we always use in a powdered state, for reasons 
connected with our mode of applying it ; this quantity 
would be quite inadequate, were its direct application 
to the very mouths of the seminal ducts, subject to the 
least uncertainty ; its action would be quite useless, if 
deposited within even half an inch of their openings in 
the urethra. Monsieur, Lallemand's instrument for this 
purpose is in my opinion subject to the variation of at 
least one inch in the deposition of the caustic, even in 
the most careful hands. 

In the instrument I am about to describe, there can be 
no possible doubt of its exact application to the ducts ; 
indeed the surgical reader will see by the description, and 
a glance at the cut that it must fall directly upon them. 
All that has to be remembered previous to its descrip- 
tion is, that the ducts open, making all allowances for 
possible differences, from half to three quarters of an 
inch from the entrance of the urethra in the bladder. 

A catheter of small size, without any other holes, is 
pierced with a slit one eighth of an inch in width, and 
three quarters of an inch in length, which ends half an 
inch from its point : a round and oblong box, which 
which will hold the requisite amount of powdered 
caustic, and has a free opening in its lower side, corre- 
sponding with the slit, is attached to a rod of sufficient 
length, and thereby pushed up to the extreme end of 
22 



254 SURGICAL TREATMENT 

the catheter, occupying and filling the half inch beyond 
the slit: in this box the caustic is deposited, after hav 
mg been drawn down by means of the rod till its open- 
ing appeared opposite the slit in the catheter ; as soon 
as it is charged, it is thrust back to the end, and is, of 
course, closed thereby. 

The surgeon passes the catheter slowly into the blad- 
der, the patient standing, and knows that the urine can- 
not appear till the slit enters the cavity : the point is 
then better than half an inch within the bladder, the slit 
lying just beyond tbe ducts: drawing the catheter for- 
ward just enough to prevent the issuing of the urine, 
will bring the slit exactly over them. The surgeon 
now draws the rod forward, when the opening in the 
box comes opposite the slit in the catheter, and the 
caustic falls in a pure and dry state upon the mouths of 
the ducts: any little moisture will gravitate towards the 
curve of the catheter, as the patient is standing. I have 
attached a small piece of sponge to the rod, between the 
slit and the box, which not only prevents the possible 
access of the urine to the caustic, but in passing over 
the ducts, removes any moisture or mucus that may ad- 
here to them. If the box is neatly fitted, this is not re- 
quisite, but it is perfectly practicable, and renders the 
instrument beautifully complete and effective. 

I have but one caution to give in passing this instru- 
ment, or any other for this purpose. There is very of- 
ten a relaxed and puffy condition of the mucous mem- 
brane, aud also of the prostate gland, and perhaps an 
enlargement of the latter which opposes its progress. 
There is also a spasmodic affection of the anterior edges 



OP SPERMATORRHEA. 255 

of the levator ani muscle on either side in contact with 
the membranous part of the urethra ; in an irritable 
state of that canal, these edges may grip the instrument 
and for some minutes oppose its entrance into the blad- 
der ; this requires the utmost steadiness of gentle and 
continued pressure ; no force must be used greater than 
the very moderate effort of the thumb and two first fin- 
gers may make, on the most delicately made catheter, 
without bending it ; the patient always standing, as the 
pressure and direction of the instrument can only be 
properly estimated in that position. I would never re- 
commend a catheter too delicately made, however, as 
its bending or cracking might produce laceration of the 
urethra in withdrawing it ; I only wish to convey an 
exact idea of the necessary pressure which the surgeon 
will often have to exert in these cases, by a suitable il- 
lustration. 

The instrument may then be withdrawn and the patient 
instantly feels a slight burning. After a minute has 
elapsed he may pass his water if he pleases : sometimes 
it may be an hour or so before he can effect it ; this is 
of no consequence ; the ability will come by waiting. 



I have added in describing the speculum alluded to 
at page 215, with a slight alteration in the manner of 
making it, the account published in the Boston Medical 
and Surgical Journal, with a plate : also one of the im- 
proved catheter for applying the caustic in stricture, 
described at page 144. It is simply a longitudinal 



256 DESCRIPTION OF PLATES. 

section, and will enable any instrument maker who is 
willing to yield sufficient attention to the description and 
plate, to prepare it with perfect accuracy. 

The plate of the instrument for applying caustic to 
the mouths of the seminal ducts, described at page 254, 
is also a longitudinal section; and the Polypus Ligator 
alluded to at page 205, is figured a little less than half 
the size : the description and mode of application fol- 
lows that of the speculum. 

The catheters in the plates are half the proper length; 
the curves and diameter as intended when made : that 
for spermatorrhea is smaller at the point : this is intend- 
ed to pass more easily, in spasm of the muscles alluded 
to in the preceding page, and to keep the opening in the 
box true to the convexity of the catheter, so as to retain 
tlv 1 caustic 



NEW SPECULUM UTERI. 257 

DR. DIXON'S NEW SPECULUM. 

[From the Boston Medical and Surgical Journal.] 

It is to be regretted that an instrument so valuable in 
principle as the speculum, should for so long a period 
have failed to fulfil the entire object of its distinguished 
inventor. That this is true, I believe most practitioners 
accustomed to its constant use will admit. An exten- 
sive, and I regret to say somewhat miscellaneous prac- 
tice, (I allude to quality) requiring the constant use of 
the speculum either for the uterus, rectum, nostrils, or 
ear, has convinced me that the construction of these in- 
struments is not only defective, but in many instances 
utterly subversive of the object intended by the operator, 
viz. : a distinct view of the parts. I must assert with a 
degree of confidence only excusable from constant fa- 
miliarity with* the use of every variety of these instru- 
ments, and the perfect liberty of aspersion to which this 
expression of opinion subjects me, that one of the prin- 
cipal objects sought for in their construction, viz., re- 
flection, is utterly thwarted by the second and para- 
mount necessity, dilatation. Thus the speculum of 
Ricord, with its two or four broad and massive burnish- 
ed blades, becomes useless as a reflector, when dilated 
as it must be if the os uteri is to be seen at all, whilst 
the breadth of the blades prevents a proper examina- 
tion of the mucous membrane of the vagina. Now the 
question is, and it can only be properly referred to prac- 
tical men, is the reflection of any consequence what- 
ever 1 I think a negative answer will be given ; and 
22* 



258 NEW SPECULUM UTERI. 

if so whence arises the necessity for their massive and 
expensive structure ? 

The accompanying draught illustrates the instru- 
ment : it is in every respect, including the thickness of 
the wires and dimensions of every part, precisely what 
has proved a very efficient instrument in my hands. 
Six steel rods four inches in length, of very hard drawn 
wire, are inserted equidistant into a hrass or steel ring 
or collar, one inch and three-eighths in diameter, from 
the centre of each hole to its opposite. These holes 
are drilled so as to give a flare of two inches from the 
probe point of each wire to its opposite ; the probe 
points are made of common solder ; the handle is of 
wire twice as thick as the rods. A small eye of solder 
is attached to the lower rod, through which a strong 
cord of six strands of silk is to be reeved, encircling the 
other five rods, and one end is to be passed each way 
through the eye, and then both brought out of the mouth 
of the speculum. Pulling on the two ends of the cord 
will bring together all the probe points, the eye being 
the fulcrum. When closed, wind the cord round the 
handle and introduce the instrument at your leisure, in- 
structing the patient to be calm and avoid resistance. 
Then unwind the cord and allow the rods to expand. 
The whole vagina is thus exposed. Should you desire 
to excise a small tumour, or remove folds of the vagina, 
for prolapsus, (an operation, by-the-bye, which will come 
into general use, and which I have repeatedly done 
with success) the rods become a guide, and with a long 
and slightly curved scissors, the folds may be excised 
with as much accuracy as in hare lip : very distressing 



POLYPUS LIGATOR. 259 

cases of prolapsus may thus be cured. In the treatment 
of chancres, and diseases of the neck of the womb, the 
instrument is quite indispensable. After the application 
of nitrate of silver for leucorrhea, as described at page 
215, the rods will require to be instantly polished to per- 
fect brightness, or they will rapidly corrode after use. 

This instrument has just been beautifully made by 
Mr. William E. Rose, son of Peter Rose, surgeon's 
instrument maker, 412 Broadway, New- York. 



DIXON'S POLYPUS LIGATOR. 

A description and plate, with several cases of the 
application of this instrument to uterine polypi, was also 
published in the Boston Med. and Surg. Journal, Vol. 
xxx. No. 1. The plate appended is a vertical section of 
a little less than half the size of the polypus and distend- 
ed uterus, as they most frequently occur, though they are 
subject to great variation in dimension s,<fcc, see Denman, 
Hunter, Dewees, &c. The writer has lately removed 
one the size of a goose-egg. 

The instrument, maintaining its proportions as fig- 
ured, may be adapted to any size, and can be prepared 
with the utmost neatness and despatch by a common 
tinman. It must be made of hard drawn wire, one- 
sixth of an inch, and no less, in diameter, or it would 
not have sufficient resistance to be handled properly. 
Two probe points of solder are to be attached to the 
ends, and perforated, so as to admit a strong ligature 



260 POLYPUS LIGATOR. 

of six strands of silk. A small knob is appended to the 
handle, round which the ends are to be wound when 
the tumor is strangulated. 

The surgeon is to pass the instrument closed, on his 
left index finger, over the abdominal aspect of the tu- 
mor. As soon as it has passed fairly into the womb, it is 
suffered to expand, thereby bringing the ligature athwart 
the tumor ; pass it steadily as far as it will go, and then 
depressing the whole equally, it may be strangulated by 
several turns, or a single one, which will cross the 
thread ; traction on the ends of the ligature will then 
answer the same purpose, winding them in either case 
round the knob on the handle. If the latter method is 
adopted, the instrument may be withdrawn at the end 
of twenty-four hours, leaving the ligature ; the vitality 
of the tumor will be destroyed by that time. Unless the 
surgeon is familiar with its use, however, he had better 
twist it a little daily, and suffer the instrument to remain, 
the patient lying in bed till the tumor and instrument 
come away together. All that part of the neck of the 
polypus that is beyond the ligature, and between it and 
the womb, will be as effectually destroyed as though it 
were included ; experience proves that it invariably 
disappears. 




Speculum Vagina. 



23 



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APPENDIX 

TO THE NINTH EDITION 



ON THE TREATMENT OE STRICTURES BY INTERNAL 
INCISION. 

It will excite no surprise in those who have watched the 
progress of operative surgery for the past ten years, that the 
ideas of surgeons have undergone extraordinary changes in 
regard to the treatment of Stricture. The natural inclination 
we all have to follow the dicta of the books, and to be guided 
by the cautions of our surgical instructors, predisposes us to 
follow in the train of those who are governed by the " authori- 
ties." But those venerable gentlemen, " the Fathers," in all 
the branches of science, have been so long standing on the 
shore of time, and casting their old drag-net into the stream 
of Tradition, that they have encumbered it with a vast 
heap of rubbish. 

In showing the reader that we have been too long governed 
by the authorities in treating this aggravating affection, I 
shall be obliged to retrace the steps by which I attained the 
conviction that I had been exceedingly stupid, in yielding 
credulity to such traditionary practice as fill our surgical books. 

It is now ten years since this book was published, and 
the great extent of its circulation has furnished the author 
with a vast experience, in addition to a very extensive practi- 
cal acquaintance with the subject, during fifteen years 1 surgi- 



266 APPENDIX. 

cal practice preceding its publication. About six years since ; 
after eight editions of the book had proved ray full assent tr- 
ail the cautions expressed in the two chapters on stricture 
(which I have left unaltered, because I think they will lend 
force to this appendix, and guard the surgical dogmatist 
against too great devotion to authority,) I was mortified by 
the announcement of a patient I had failed to cure, that he 
had been to Edinburgh, and had his stricture incised by Mr. 
Syme, and after a very few times passage of the largest sized 
bougie, he was permitted to return home, perfectly cured. Now, 
this gentleman's stricture could be readily dilated, and it had 
repeatedly been done by myself, so as to make him comforta- 
ble for weeks ; but the least change of temperature, or 
irregularity of diet, would bring it on again as bad as before ; 
and yet it was evidently not spasmodic, because it could only 
be dilated by the usual process of the bougie ; anodynes had 
no effect whatever ; nor would it disappear again, under two 
or three weeks dilation ; in short, it was, as all such cases are, 
a perfect nuisance to the patient and the surgeon. 

Here was a case which every practical surgeon would have 
pronounced an unwarrantable one for the operation ; and yet, 
it was incised by Mr. Syme, and that on the second visit, and 
then speedily cured by dilation ! I did not lose this experience, 
the reader may be sure : but as I was still laboring under all 
the surgical learning of half a century of authors, I determin- 
ed to find the reason of this cure, and to convince myself be- 
forehand, whether I could apply such bold treatment in simi- 
lar cases with prospects of similar results. I had often in- 
cised permanent strictures with more or less benefit, but these 
were so severe as to admit of no doubt as it regarded the 
propriety of such a course of practice. 

When a man can only pass his urine drop by drop, for 
months together, and it is impossible to pass a bougie at all, 
there is certainly no other course to be adopted, than to cut 
carefully through the stricture, and then, keeping the patient 
on his back, to heal up the incision over the catheter. In the 



APPENDIX. 267 

case of my patient, Mr. Syme's incision had evidently 
cured the disposition to contract, for the patient had no 
further trouble, though he took no special precautions of diet 
or clothing, other than before he went to Edinburgh. Mr. 
Syme incised the stricture in his peculiar way ; he passed a 
delicate grooved probe through the natural opening of the penis, 
and carried it through the stricture ; then piercing the skin with 
a very delicate knife, he passed its point into the groove of 
the probe, and thus divided the stricture in one place only — 
on the lower side of the urethra, of course, as that is the 
place where the edge of his knife would come. The wound 
healed up readily, and the patient was cured by a few passa- 
ges of the bougie. 

Now, let us consider this case. The stricture, after Mr. 
Syme's incision, was in all respects, as it was before, with the 
exception of that single cut. What had this cut done ? Why, 
it had divided the lining or mucous membrane of the urethra, 
and the contractile coat outside, and surrounding it. That is 
all; and what else? Why, the cut immediately healed up 
again, and became just as it was before ! Not so fast, reader ; 
— it left a cicatrix, or as people call it, an eschar, running its 
whole length, and this, it has been said, will always, of itself, 
contract any part of the body where it occurs. Here come the 
" authorities" again, to cripple our practice. 

The '* invariable " rule only applies to the outer skin of our 
bodies ; not to the mucous linings. 

But there is more reasoning to be done here ; whatever 
the immediate mode of action that induces the contraction 
of this part after exposure to cold, irregularity of diet, or a 
debauch, — and renders the interference of the surgeon neces- 
sary to procure a passage of urine — I say, whatever its mode 
of action may be, the cause acts upon the entire mucous lining 
of the urethra, all round the bore of the stricture, and the 
contractile part outside of it. This is evidently interrupted 
by Mr. Syme's process. Stricture, the reader will remember, 
is always owing to irritability ; a spot in some portion of the 



268 appendix. 

urethra becomes more inflamed than the rest, as in clap, 
and contracts ; or the person receives an injury by a fall on 
the edge of a board, striking on the urethra, which leaves the 
part contracted, and opposing the free passage of urine. Now, 
please to remember, the urine is always an irritating fluid, and 
the lining membrane of the urethra is supplied by nature with 
a great number of little glands that throw out mucus to sheath 
it, and protect it from the urine, and allow it to pass rapidly 
over its surface, and be thrown out of the body. If any por- 
tion of the passage be contracted in its diameter, the urine 
accumulates behind the contracted part or stricture, and irri- 
tates it by its acrid properties ; it stays longer in contact with 
the strictured part as a matter of course. While it is seeking 
to pass the strictured part of the passage, the bladder be- 
comes irritable, either from the quantity or acrid quality of 
the urine, and contracts spasmodically, in order to force it 
through the stricture ; this reacts in the same spasmodic way 
by means of the contractile coat of the urethra which lies 
immediately next the mucous membrane, and thus the attack 
goes on, till the surgeon, either by half-poisoning the patient 
with opium, or other narcotics, and parboiling him, and 
wilting him in a warm bath, succeeds in passing through the 
stricture the smallest bougie, or the patient without it, passes 
the smallest possible stream of water. 

All this, it will be remembered, will probably re-occur 
on the first occasion of a debauch, or taking cold, or even on 
using some indigestible food: wet feet is a frequent cause. 
Meanwhile, the patient is deprived of all the privileges of 
manhood, and is loathsome to himself and those around him : 
either his urine is passing from him drop by drop, or it 
is being absorbed and thrown out of his skin, scenting 
the atmosphere of the apartment, and rendering him an unac- 
ceptable companion to all. 

Although recent cases of stricture are often cured by us, 
particularly if the patient will consent to lead a rational life, 
still they far oftener pass into extreme irritability and obsti- 



APPENDIX. 269 

nacy, and finally demand the measures enumerated in the 
chapter on the cure of strictures. 

We are now convinced from a very large experience of Mr. 
Syme's practice, that incisions of the mucous membrane 
alone will interrupt this process of irritability and congestion, 
and cure the stricture ; we will explain our views as to the 
rationale. 

There can be no possible propriety in any mode of treat- 
ment or in any operation for stricture, which does not leave 
the contracted portion of the urethra in a state less irritable 
than it was when it compelled the patient to seek surgical 
aid. This irritable state shows itself by action: and that 
action is the spasmodic contraction of the entire circle of the 
mucous membrane lining the stricture ; it has its own reason 
for contracting, and it obeys it; although that obedience 
evinces disease ; it is the law of the disease. Now this con- 
traction requires the continuous action of a little circle 
of the contractile portion of the urethra, every fibre of 
which is essential to the manifestation of the disease; 
the incision interrupts this action: although the cut part 
immediately unites again, still the circular fibres have been 
interrupted — and, when the cicatrix forms, it is a new and 
more recently organized substance, and one not controlled by 
the same law as the original fibre, which was obliged, by vir- 
tue of its organization and inflamed condition, to contract. 
This is the simple explanation, and no doubt it will be satisfac- 
tory to the thoughtful and timid practitioner. 

The fact that severe and impervious cases of stricture, such 
as we have hitherto been accustomed to incise, have been 
observed to lose their irritability for a long time, if not for 
good, after the operation, and to become entirely manageable 
by the patient himself, ought to have given surgeons a hint 
to incise them long before Mr. Syme's proposed it : thus it is, 
however, and thus it ever will be ; pride of mere learning (a very 
worthless thing without reason) and indolence, will keep men 
from the most admirably useful discoveries : and, when saga- 



270 APPENDIX. 

cious men really discover a great truth, there will always be 
some old fogies ready to thrust the "authorities" before 
their faces, and to try to frighten them away from thought. 

After I had convinced myself of the rationale of Mr. 
Syme's method, I drew upon my mechanical habits for an 
instrument sufficiently delicate to incise the stricture, with- 
out puncturing the skin. We had long possessed various con- 
trivances for the purpose, such as concealed knives— that 
could be thrust from the end of a bougie, as described in the 
chapter on strictures — but these were neither accurate nor 
delicate enough to incise the mucous membrane alone; for I 
resolved to test whether this alone was not sufficient in all 
cases that were not of long standing, or such as were marked 
by their irritability chiefly. After many trials, I succeeded 
in getting a very admirable one made by Tiemann, of 
Chatham street, who always can, if he will (but who, unfor- 
tunately, seldom wills), make excellent cutlery. 

This instrument is not much thicker than a common knit- 
ting needle; it will pass through the smallest stricture, and, 
by screwing up a style that passes through it, a small knife is 
raised at any required angle, with the shaft. As the urethra 
is elastic, in all cases where the stricture is not permanent 
and hardened, I have found that full one quarter of an inch 
will only incise the mucous membrane alone ; at least, 
I judge this to be the case, from the little disturbance 
and the few drops of blood which appear. I often make the 
incisions on two sides, by closing the blade, and then passing 
it again through the stricture, turning it round, so as to pre- 
sent the blade on the opposite side, and then screwing it open 
again ; even when I have done it, as in a few instances, on 
three sides, there is little or no pain or disturbance — and, 
after the first urine has been passed, the patient often expe- 
riences the greatest relief, even before a bongie has been 
passed at all. No doubt this is owing to the interruption of 
the morbid action encircling the stricture, as well as to the 
depletion by the loss of blood from the part; for, doubtless, a 



APPENDIX. 271 

considerably larger amount than we see im mediately after the 
incision is made, is passed off by the urine. 

I have now used this instrument in a great number 
of cases, and find that we have been entirely deceived in our 
views of the serious character and utility of the incision of 
stricture. Mr. Syme's method of external puncture, I con- 
ceive, however, to be quite unnecessary; not only because it 
is a much more complicated and serious measure, but more 
especially as it requires the patient to lie on his back for 
several days, and the presence of the catheter for the urine 
to pass off; this is, undoubtedly, unnecessary, and, therefore, 
while I cannot forbear expressing my obligations to this dis- 
tinguished surgeon, I hope I may claim some slight merit for 
the suggestions, and the few thoughts I have advanced for 
their guidance in the application of this great principle in the 
treatment of strictures, for such I am satisfied it will prove 
to be. Most of my patients have been sent by those who 
have experienced in their own persons the benefits of the 
treatment; and I should be mortified if this publication should 
fail in inducing every practical surgeon to adopt it without 
the slightest fear; it only requires that tact and delicacy 
which every practical man possesses : if he will attend to the 
structure of the part, its capacity of resistance, and the simple 
mechanism of the instrument, his first attempt in its use will 
be as successful as any other man's : there is nothing to 
be feared, and nothing wanting but common «ense, in 
its use. 






212 APPENDIX. 



CIRCUMCISION— ITS REAL OBJECT— A NEW METHOD OF 
CURING SEMINAL WEAKNESS. 

TnE great number of cases of seminal debility, accompa- 
nied by nocturnal or diurnal' emissions, will compel the prac- 
tical surgeon to look out for every possible cause that tends 
to produce so baneful a result. In thus expressing myself, I 
do not allude to those perfectly healthful emissions that occur 
in athletic young men who are wise enough to be continent, 
nor yet to the acknowledged victim of self-abuse; but I think 
that every humane and philosophical man, will endeavor to 
discover every cause that can possibly operate to produce 
that frequent and prostrating irritability of the seminal appa- 
ratus, that is unfortunately so common in this country. It 
has bee"n the fashion of late, for some well-meaning men, 
"whose opportunities of surgical observation. are limited to 
&ome rural district, to decry such honest instruction as several 
very good writers on Hygiene have given in popular treatises, 
and to allege that it was done from interested motives only. 
It would not be difficult to circumscribe all action, physical 
or moral, in such a contracted category : but I apprehend 
that the motives of Moses will require no defence of mine, 
any more than the lawgiver would the instructions now given 
for the performance of an operation unwisely neglected by 
many Christian parents, when its necessity ought to be evi- 
dent, from the frequent deformity of their offspring in this 
part of the body. The Jewish people were wiser; and in 
making the shortening of the prepuce or foreskin a religious 
ceremony, they ensured a great hygienic result. 

Perfect ablution, and the free access of the air to the deli- 



APPENDIX. 213 

cate tissue covering the glans penis, will do more to preserve 
young men from specific diseases and seminal debility, than, 
all the morality they will imbibe from those well-meaning 
but short-sighted people, who oppose popular physiologicax 
books, in a lifetime. 

Excessive morbid irritability, which will not allow the 
genital organs to be touched without producing prurient feel- 
ings, is almost always present in those persons who are unable 
to denude the glans by slight pressure with the fingers, and 
I have observed them to be liable to frequent nocturnal emis- 
sions. It is evident to common sense, that where cool air and 
soap and water can act freely on the part, not only the liability 
to venereal poisons is lessened, but the healthful tone of the 
part is more likely to be preseived; the proper growth and 
expansion of the organ is so plainly checked by it, that the 
proportions of those who labor under the deformity of " phy- 
mosis," are actually infantile, and they often seek the aid of 
the surgeon merely from mortified pride. 

No method for the performance of this operation can pos- 
sibly compare in excellence with that practiced by the Jews ; 
and I always adopt it when called on to operate on children : 
it consists in excising the redundant skin, in a slanting man- 
ner, equal to the obliquity of the glans, which is completely 
protected, and the part to be excised presented to the edge of 
the knife, by drawing it forward, and holding it firmly be- 
tween the blades of a forceps ; after the excision, the mucous 
membrane, from which the outer skin shrinks considerably, 
is folded over to meet it ; and the parts soon unite and leave 
the "glans" denuded for life, ensuring- cleanliness, and pre- 
venting'the unnatural moisture of the part, and its consequent 
irritability. 

But this method is too formidable for most people to sub- 
mit to, when the organ has attained a larger size. Accord- 
ingly, the French have adopted the following plan : passing a 
small grooved director through the narrow opening, and 
under the superior part of the prepuce or foreskin, and carry- 



214 APPENDIX. 

ing it just as high as the glans, with a very sharp-pointed 
knife, guided by the grooved director, the surgeon pierces the 
foreskin, and completely divides it, cutting towards himself; 
there may be now quite a smart bleeding, which will soon 
stop without securing any vessels. A singular result always 
follows, which is difficult to believe till you have seen it ; but 
as it depends upon an organic law inherent in the divided 
skin, it always follows ; we allude to the fact, that when the 
single straight cut is made through the foreskin, as shown in 
the first figure, it instantly assumes, by the peculiar contrac- 
tion of the skin, a transverse position, as shown in the second 
plate, partially encircling the penis, and ensuring the retrac- 
tion of the prepuce just where it ought to be, as in the natu- 
ral formation, where it is so short as to leave the glans ex- 
posed ; three separate stitches with a cambric needle and 
thread should then be passed through both cut edges by the 
slightest hold, so as to approximate the delicate mucous mem- 
brane that lines the prepuce with the divided integument or 
outer skin of the penis, and no dressing whatever applied : 
if the patient remain quiet, and there be no bleeding, it will 
unite by adhesion as easily as a cut finger, and he is for ever 
clear of this ridiculous and infantile deformity. Under the 
most unfavorable circumstances, however, after a few days 
the cure is always complete — the irritability is removed, and 
the patient's proportions assume the size intended by Nature. 
There is not a doubt on my mind, that there is an electri- 
cal law by which irritability of the glans penis, when con- 
stantly moistened by the contracted prepuce, as well^as irri- 
tated by the foul secretions that are thrown out by the glands 
surrounding it, is propagated to the irritable vesicles and their 
outlets, that store the semen, and lead it into the urethra ; 
hence, the seminal debility. I have cured many cases, on 
which cauterization, and diet, camphor, lupuline, and the 
cold doiiune had no effect, by this simple operation alone ; 
nor, have I a doubt, its invigorating and hygienic effect was 



APPENDIX. 215 

a€ the bottom of the law enforcing circumcision. "We subjoin 
the two plates for the benefit of surgeons. 

The first shows the deformity requiring the operation, and 
the director passed under the prepuce ready to receive the 
knife. 

The second, the divided part, as it appears an instant after 
the operation, and before the insertion of the stitches; the cut 
has become transverse by the retraction of the skin of the 
penis pulling tack the sides of it. The two plates at the bot- 
tom of this, page 276, relate to the next article on the abor- 
tive urethra. 



APPENDIX. 2 IT 



ABORTIVE URETHRA : A NEW OPERATION. 

Theee is an affection of a very remarkable character in 
which the natural opening of the urethra in the glans or end 
of the penis, does not exist ; the child is born so ; a mere 
hole on the under side of the urethra, sometimes half way- 
down, being the abortive termination of that tube : this hole, 
however, usually exists in such cases, only half an inch from 
the end of the penis ; and is the source of great mental distress 
to the unfortunate- young man, as soon as he becomes aware 
of the proper natural formation. The abortive or unnatural 
opening, of course, answers the purpose of evacuating the 
urine ; but the sexual act is often rendered unfruitful from the 
defect ; always so, when the hole occurs half way down the 
organ, as is shown in the plate on page 277. 

The operation alluded to in chapter eight, is not at all appli- 
cable to such a condition of the parts ; as there i3 a constant 
tendency of the puncture to contract by the natural approxi- 
mation of the parts ; in short, that operation is only appli- 
cable to slight cases. 

I have lately succeeded in restoring a very bad case to its 
natural state, in a fine young man, who sought my aid, from 
the West : the opening was full two inches from the proper 
ending in the glans penis ; it was the source of the utmost 
anguish to the patient, as he was one of the finest specimens 
of American youth, and desirous of entering the state ot 
marriage with a young woman, to whom he had been 
attached from infancy. I stated the doubt of success with 
the utmost candor to the patient, assuring him I had never 
known so bad a case successfully operated upon. 



2t8 APPENDIX. 

He had, however, imbibed such extraordinary ideas of my 
mechanical ability, and such assurance of success, that though 
I resolved to attempt to aid him, I did so with a painful con- 
viction of failure. 

This fear originated from the anticipated derangement of 
the parts, from the unavoidable erections in sleep tearing out 
the stitches, by which I intended to approximate the edges of 
the skin, which I should loosen on either side of the abortive 
urethra, and approximate its edges over the catheter, as shown 
in the subjoined plate, which is inserted for the benefit of 
surgeons. Dr. Sims, of this city, suggested to me his beauti- 
ful device for approximating the opening in the female parts 
between the bladder and vagina, an accident never cured by 
a correct surgical principle till done by that gentleman : his 
"clamp sutures" I believe to be the only means of carefully 
approximating the cut edges, and holding them in contact 
undisturbed during the unavoidable erections of the penis, 
before complete union could occur of the two flaps, as seen 
approximated in the plate. 

The following were the steps of the operation : — With Mr. 
Arnott's mixture of two-thirds pounded .ice and one-third 
salt, enclosed in a bag of gauze, I so chilled, in five minutes, 
the parts to be cut, that I made, without pain, two incisions 
through the skin a quarter of an inch from the central line 
dividing the penis, where there is a trace of the mucous mem- 
brane of what was designed to be the lining of the superior 
part of the urethra ; these incisions extended from the glans 
to either side of the abortive opening of the urethra; I then 
dissected towards the central line of mucous membrane, and 
completely raised them from the body of the penis for the 
length required, leaving about a quarter of an inch of each 
side the central line, or that which lies under the bougie in 
the plate, untouched by the knife ; then, allowing the part to 
recover completely from the chill, so as to see if any blood 
would ooze away, and wait till it was done, I passed a large 
bougie into the bladder and raised up the two flaps; ap- 



appendix. 2*79 

proxiinating them over the "bougie, I passed six delicate 
annealed silver wires, each wire previously knotted at one 
end, and the other passed through each of six holes in a strip 
of lead two inches long, and a line thick: the free ends were 
passed through the edges of each flap by means of holes made 
with a cataract needle, and then through similar holes equi- 
distant and corresponding with those made in the first leaden, 
strip, in another similar slip on the other side ; then passing 
a drilled buck-shot over each free end of the wire, and bringing 
the edges of the flaps cut to cut, I squeezed each shot with a 
cutting pliers, and found the edges to meet beautifully. I 
kept the patient on his back for six days, but was obliged to 
withdraw the bougie on the fourth day, in consequence of the 
irritability of the part, notwithstanding the liberal use of 
morphine, with which he was kept continually dozing ; I did 
not, however, allow him to pass his urine till the tenth day, 
drawing it off twice a day after I had withdrawn the larger 
one, by means of a small catheter. The necessity of remov- 
ing the large one, which was essential as a means of ready 
passage for the urine, as well as a mould for the addition 
made to the existing portion of urethra in a very large penis, 
had been anticipated by me as the most likely thing to ren- 
der the operation fruitless. The sutures were removed on the 
tenth day. 

In a similar case, I should not let the large catheter remain 
over the third day ; as the clamp suture keeps the parts so 
admirably together as to insure rapid union ; let me caution 
the surgeon, however, not to trust the patient to pass his 
urine for ten days, as the irritation of the urine might cause 
inflammation. 

The expressions of gratitude of this fine young man will ever 
beheld in my remembrance ; I consider the result, however, due 
entirely to Dr. J. Marion Sims, of this city, whose beautiful 
contrivance of the clamp suture enabled me to keep the parts 
together. The third and fourth plates, page 276, show the 
deformity, and the parts brought together with the catheter 
in the tew passage. 



280 APPENDIX 



THE OPERATIONS FOR VARICOCELE. 
See Part Seco?id, Chapter XII. 

There are so many persons who object to cutting operations, 
as well as occasional trouble from bleeding under the skin in 
the loose tissue of the scrotum, that many surgeons entirely 
repudiate them for varicocele, and substitute compression of 
the veins and the ligature : the first is effected by two little 
oblong steel pads, which receive the enlarged veins between 
them, the surgeon having secured them in front of the sper- 
matic duct and its artery, by means of his thumb and finger : 
a screw brings them together, passing through the ends of 
each, and just clearing the skin of the scrotum or purse for 
the testicles : this method will obliterate the veins in a few 
days, but it is quite painful, and ulcerates the skin, which is 
unavoidably compressed to reach the veins. 

The second method consists of passing a long silver pin be- 
hind the group of enlarged veins, and then another in front 
of them, both entering and emerging at the holes made by 
the first. The reader will perceive, that turning the ends of 
these two pins between the fingers, will twist the enlarged vein, 
and shorten it, raising up the testicle ; a few days effects the 
obliteration of the vein and its adhesion, so that it stays 
shortened and impervious: the pins are then withdrawn, and 
the person is cured. This is a safe and sure method. 

Another plan is a very ingenious one, and amounts to the 
same thing as the ligature made by cutting through the skin, 
raising the veins, and then tying them : but it is rather more 
complicated and surgical in appearance : it consists in passing 
a double ligature under the veins, leaving a loop m Hi 8 ai.'Je; 



APPENDIX. 281 

then passing another double ligature through the loop and 
through the same hole in which it was brought out, in front 
of the veins and directly under the skin : making a similar 
loop come out of the opposite hole, and passing the tails of 
the first ligature through this second loop : drawing right 
and left the tails of each, will strangulate the enclosed veins ; 
the cut will explain it better than we can : but it has no ad- 
vantage over the common ligature, or what surgeons call the 
figure of eight ligature over the pin, which is shown by the 
last cut; it consists in passing a single pin under the veins, 
and then compressing them against the inner part of the skin, by 
twisting a thread, figure of eight fashion, from one end of the 
pin to the other, outside of the skin. I prefer to all the others 
here figured, the two wires ; for they are both certain and 
manageable; at once obliterating the vein, and shortening 
the cord : moreover, if severe symptoms come on, it is easy to 
withdraw the wires : after three or four days, it may usually 
be considered successful. 



LOSS OF VIRILITY IN YOUNG MARRIED PEOPLE—AN 
•UNSUSPECTED CAUSE. 

It is not to physical derangements only, that the extinction 
of passion is due; nor yet to the evil practices of youth. A 
man may be so fortunate as to be perfectly formed, and 
escape the pernicious influence of evil instruction at school 
he may marry happily ; his blood may be pure, and his pros- 
pects bright, and yet from ignorance of a great law of Nature, 
he may, in a few years, find himself prostrated in all his 
manly energies, and his very soul become dead within him, 
whilst he may be utterly oblivious of the cause. I know of 
nothing more positive in its /depressing influence upon the 
nerve power of our sex, than that insidious one, of a partial 
performance of the sexual act so common amongst the newly- 
married, after the birth of one or two children, for the pur- 
pose of preventing further increase of family. Tobacco, itself, 
has a less depressing influence ; nor do I think that the asso- 
ciate vice of drunkenness, combined, would turn the scale 
in their favor, against this awful cause of the early decay of 
manhood : it certainly ranks ahead of self-abuse, because that 
vice commences in the very morning of existence, whilst 
nature is yet gaining power, and, before the anxieties of life 
commences their devastating inroads upon the nervous sys- 
tem. As I have only space in this appendix, to notice this 
master evil of one vicious system of society, I cannot enter 
into an explanation of the theory of its wretched conse- 
quences ; indeed, I have no acceptable one to offer ; the fact 
I know from extensive observation, and the most painful nar- 
ratives of my patients; together with numerous letters of 
inquiry. 



284 APPENDIX. 

But why sh«uld it excite surprise? thiuk for a moment on 
the consequences of such a eheck continually given to that 
act by which man demonstrates the possession of God's 
greatest gift, CREATIVE POWER! What an insult to 
Nature and Nature's God! To summon up a cold, calculat- 
ing consideration, to quench the fire on that altar where man 
was commanded by God to prove his immortality! Yes, 
Creative Power is the best proof of the immortality of the 
soul ! nor do I conceive it possible to practice the debasing 
custom alluded to, without man's whole moral nature being 
crippled long before the bodily powers succumb. 

Those who consult the surgeon for the consequences of this 
vice, are usually of an order of mind very unlikely to investi- 
gate the validity of any assurance of its baneful consequences; 
because a man who has much physical or moral force would 
never long practice it, without making the discovery for him- 
self: he would rarely proceed so long with the practice, as to 
require medical or surgical treatment to restore his lost power, 
Unfortunately for the prevention of this vile habit, there are 
very few medical men sufficiently well educated in physiology, 
to have given this subject any consideration adequate to its 
importance ; and the commercial spirit of our people is but ill 
adapted to self-observation. A vast number of married men, 
by the time they have made the imagined necessary amount 
of wealth that will entitle them to rear a family, and supply 
it with all the contemptible requisitions of fashionable life, 
will find their bodily energies so crippled, that nothing but 
sickly and scrofulous beings will follow the feeble effort of 
expiring manhood: and fortunately for the next generation, 
dropsy in the head, or the summer diarrhoea, carries many of 
them off in infancy, and prevents the further propagation of 
such a miserable race. 

When the victim of this vice presents himself to the sur- 
geon, it is either for seminal debility, apparent when at stool, 
or else for a constant daily drain, without the excitement of, or 
with very little amorous emotion. It is quite useless to am- 



APPENDIX. 285 

plify the symptoms, in tins appendix; most uf those apper- 
taining to self-abuse may be found on inquiry, and a still 
greater amount of despair, because, for the most part, the 
married victim has gone through that ordeal, previously. It 
is the consequences of that vice that usually incapacitates him 
from those manly resolves and that decision of character which, 
had he possessed them, would have rendered such a wretched 
and calculating conclusion as a desire to limit his offspring, 
unnecessary and repulsive to his feelings. 

The surgical appliances calculated to benefit such cases, are, 
electricity and cauterization. Sometimes the patient may 
derive benefit from irritants applied to the spine, as low down 
as possible, and continually repeated ; at the same time, Mar- 
shall Hall's mode of administering strychnine, a grain dis- 
solved in an ounce of alcohol, and fifteen drops taken twice 
or thrice daily for several months, will benefit him. A long 
continued fish diet, will, by the stimulating and restorative 
properties of its phosphoric elements, assist the cure. The 
stupefying influence of tobacco must be fully acknowledged, 
for its directly prostrating influence on the genital system is 
powerful. Those methods which can prevent the production 
of offspring without this loathsome and disgusting practice, 
though not in accordance with Nature's plan, will certainly 
be attended with less prostrating results; but no man can 
entirely escape the consequences of avoiding the Divine com- 
mand, on which his healthful existence depends. 



28f> APPENDIX. 



APPENDIX 

TO THE TENTH EDITION. 

Abridged from a Lecture on the Pathology and Treat* 
ment of Stricture. Delivered to his private Surgical 
Class, in 1866, by Edward II. Dixon, M. D., Editor 
of The Scalpel, and Operating and Consulting 
Surgeon, 42 Fifth Avenue. 
Gentlemen : 

Slnce the discovery of Mr. Syrne, of Edinburgh, that stric- 
ture of the urethra is only permanently curable by incision, 
surgeons have been obliged to scrutinize one of their best 
established and most cherished dogmas; one that was sanc- 
tioned by the greatest authorities, and apparently proved to be 
true by centuries of professional scrutiny. Indeed, it had 
become an aphorism ; and the surgical neophyte would have 
been condemned to another year of study, if he did not know 
it, when asked by his " tormentor," whilst " undergoing his 
first groat sweat in the green-room." It was this: "All 
wounds, when healed, necessarily contract the parts they unite." 
In popu'ar phraseology, " Scars shrink." Now, all practical 
surgeons well know that this applies only to ulcerated wounds 
where there is much loss of substance, and especially to the 
skin, as in burns ; it is certain that the aphorism does not ap- 
'ply to incisions below the skin ; it surely does not to the 
numerous operations now performed for deformities produced 
by contracted muscles and tendons, as wry neck, clubbed foot, 
contracted joints, etc., where incisions are freely made under 



APPENDIX. *'V7 

the skin. Surgeons have, for centuries, therefore, applied a 
rule applicable to ulcerations only, to simple incisions ; and the 
consequence has been, the failure to care two of the most dis- 
tressing diseases to which we are subject, namely: "Stricture 
of the urethra, and stricture of the uterus." The former is 
but too well known in our own sex, and the latter, only un- 
suspected to exjst by reason of absolute ignorance of the 
nature of her own structure and functions, by those women 
afflicted with painful menstruation in early life, and unfruit- 
fulness when married. She would be as frequently the sub- 
ject of stricture of the urethra as man, were it not rendered 
almost impossible by the shortness of the passage, making it 
easily and constantly dilatable by the urine. The passage from 
the cavity of the uterus, in its unimpregnated state, only re- 
quiring the percolation of the menstrual fluid — as it were, 
drop by drop — and being very subject to ulceration and con- 
traction, besides having its calibre, which will hardly admit a 
pin, in its natural condition, continually contracted by conges- 
tion of the substance of the neck of the womb, through winch 
it passes — is liable to stricture ; indeed, nine women out of 
ten, who labor under difficult or painful menstruation, and are 
unfruitful, have this disease. But it is truly astonishing that 
physicians still persist in treating both these diseases with 
medicines. They belong exclusively to the surgeon, and can 
only be cured by local and instrumental treatment. In both, 
there is an alteration of structure, which, when the diseases 
have existed for some time, has become permanent. Stricture 
is a tMckening of the natural tissues lining the respective 
passages from the bladder and the womb, making them 
smaller than natural. This thickening is the result of in- 
flammation ; in the urethra, it is usually caused by Gonorrhea 
or Clap ; not always, however, for there are other causes of 
inflammation ; long-continued self-abuse may cause it. It is 
only necessary to apply irritation to the urethra, and to con- 
tinue that irritation long enough, for inflammation and 
thickening: to occur in the lining or mucous membrane, and to 



288 APPENDIX. 

extended far enough, beneath it to produce "stricture." It 
may originate from mechanical injury. We have had very 
bad cases of stricture from kicks between the legs ; also from 
falling astride of a rail ; and in one instance the tail of a 
wagon-board, astride of which a man alighted suddenly. The 
use of that shockingly dangerous instrument for cauterizing 
the openings of the seminal ducts, (Lallemand's Port Caus- 
tique,) has made a few of the worst strictures we have seen. 
As these result lrom the contraction of an irregular ulcer of 
indefinite extent, produced by the caustic, the cicatrix forms a 
stricture of no describable shape ; the passage being so dis- 
torted, that its natural continuity can never be restored ; the 
only resource of the surgeon is, to cut through it in a curved 
line, and form a new passage. We have also had several 
severe strictures under treatment from local inflammation, 
caused by the continued passage of bougies by the patients 
themselves, when pursuing the old method of dilating the 
stricture with bougies. 

The barbarous method of forcing through a stricture with a 
conical bougie, and piercing it, with a pointed one, will often 
greatly increase it ; indeed, it is impossible, at this moment, to 
recall an accident, or evil result of practice, that has not 
afforded us one or many examples of stricture. 

Strictures vary in degree, from the twelfth of an inch to two 
inches in length : we have had examples of more than three 
inches of the urethra obstructed by one or more strictures of 
almost cartilaginous hardness. They arc rarely at the open- 
ing or mouth ; most frequently they are situated at tliWfourih 
or fifth inch of the urethra, when that passage is seven inches 
in length ; it is not usually longer : stricture rarely exists at 
the neck of the bladder 

SYMPTOMS. 

Men are so unaccustomed to observe correctly their own 
feelings, and to trace out the causes that interrupt that 
harmony of action which constitutes health, that it is quite 



APPENDIX. 2S9 

difficult to convince them of the existence of any other symp- 
toms of stricture, than such palpable ones as the usual persis- 
tent gleet, or white discharge (which is always the first symp- 
tom of stric.ure), a great diminution of the stream, or occa- 
sional absolute obstruction to the passage of the urine. Now 
one would suppose that it could hardly be possible to overlook 
a diminished stream, amounting to one half what it should be 
in health ; but that is a matter by no means easy to determine ; 
we have only to reflect, that if an ordinary lead pipe, of a 
similar calibre, delivering a stream of its own size, should 
receive a blow, causing a dent that should diminish it by one 
half that calibre, it would still deliver a stream in appearance 
quite as large as before ; but that stream would not be round 
and continuous, nor could it be projected as far from the 
orifice of the pipe as it would have been before the dent was 
made ; it would be spiral, or more or less like a cork-screw, 
scattering at the orifice, and it would fall nearer the opening 
of the pipe. The patient rarely observes this, nor the in- 
creased frequency of the desire to pass his urine ; both these 
symptoms are so gradual in their approach, that they are 
rarely noticed till so marked as to compel attention. I never 
yet heard a man say he could determine when he first believed 
the stream of urine was essentially diminished. When asked 
if he has noticed any diminution, the patient will invariably 
say No — often when a number four bougie will pass with 
difficulty. Still less will he believe that nervous symptoms, 
palpitations, chills, headache, lassitude, and increasing unwill- 
ingness and want of mental force in all the business of life, 
depended upon this morbid irritability of the urethra. That 
conduit is intended by nature for the rapid passage of the 
urine, which is often very irritating, because of the redundant 
acid and alkaline secretions from the blood ; the urethra being 
the greatest waste-gate of the body. The urine is poisonous ; 
if taken into the blood, extensively, or entirely, as in cases 
where none is secreted by the kidneys, the patient dies, as 
surgeons say, of Uraemia ; he becomes stupid and dies — blood- 



290 ArrENDix. 

poisoned by the urea. Now when the passage is greatly 
narrowed by stricture from any cause whatever, of coarse the 
force of the bladder cannot act as much on the portion of 
urine beyond the stricture, as it can on that nearest the 
bladder ; therefore the nearest portion of the urethra is dis- 
tended, often to double and triple the size of the more distant 
portion. Th's distended part becomes irritable and sore from 
the presence of the acrid urine, and its lining membrane no 
longer remains smooth, nor does it secrete the healthful mucus 
provided by nature to lubricate it, and cause it to tolerate 
the urine ; the discharge becomes thick and opaque ; and 
glues the lips of the meatus or opening of the urethra ; 
this is especially to be observed in the morning because no 
urin-j has been passed during the night to wash it away. 
This sore bag or sack, irritates the whole nervous system, and 
causes general constitutional symptoms, as above enumerated, 
chills, etc. In process of time, the stricture increases, by the 
thickening of its wall, caused by the constant inflammation, 
till the urine is only permitted to pass in a very small stream, 
or drop by drop. Cold feet, general chill, or a debauch with 
wine or women, throw the blood from the surface into the 
membrane lining the stricture, and it swells till the urethra is 
quite closed, and there is absolute retention of urine. 

It is not advisable, nor indeed, possible, within the limits of 
a short lecture, to enumerate the variety of remedies adminis- 
tered by physicians, to cause the urine to fi m. They are 
mostly inoperative and unreliable. Warmth in bed, incr, 
by bricks and bottles of hot Water, is the only reliable m 
of re-opening the passage ; if there be spasmodic efforts to ]*ass 
the urine, and the smallest catheter ran not pass, by skillful 
and gentle efforts, no time should be lost. Ether should bo 
immediately inhaled— from a funnel-shaped napkin, the ether 
being applied by means of a Bponge the size of an egg, placed in 
the funnel-point of the napkin, the patient's nose being en- 
1 by its open month, raisin? it every few seconds to admit 
theair— This is peri'er lys I safe, and should mrt 



APPENDIX. 291 

omitted. It is quite unnecessary to wait for the doctor or 
surgeon ; any person of common intelligence should at once 
proceed to do it, without hesitation, and what is more, as soon 
as the patient is insensible, he should, without the least fear, 
attempt very slowly and gently to pass a small number four 
catheter of gum elastic. He can do no possible harm, and may 
save the poor victim the greatest anguish, and death from a 
bursted bladder. I can not conceive how it is, that people 
who call themselves men, do not instruct their patients, espec- 
ially in the country, where it is often difficult to get medical 
aid, in this simple and necessary act. No man worthy the 
name would fail to do it, nor should instruction in the use of 
ether any longer be withheld in our public schools. It is the 
most effectual remedy for spasmodic diseases known to man. 
When our profession elevate their code of ethics to the height 
and adapt it to the breadth of the requirements of humanity, 
then they will have less cause to complain of the ignorance and 
ingratitude of their patients. 

If these efforts fail in enabling the patient to pass his urine, 
no further time must be lost. The surgeon (not the j)hysician) 
must be called. We will endeavor to illustrate why we say 
this, by a few type-cases. It is customary, in all the authors on 
Stricture we have ever read, not only to publish a great num- 
ber of cases, but to give all the receipts, and the regimen 
adopted in each case, and to dismiss the patient generally as 
" cured " by the same. We have no recollection of having 
" cured " a single case, in thirty-five years' experience, by the 
method of dilating with bougies ; whenever the patient has 
not left us in disgust because we demanded payment of a bill, 
or because his disease returned after a little relief by dilating 
the stricture, keeping his feet warm, and ceasing his intem- 
perance and other debauchery, he has either abandoned us 
because he was promised a cure by medicine, or he has aban- 
doned himself in despair at the result of all treatment. It is 
only since we have adopted the treatment of incision by the 
Urethrotome, that we have derived any satisfactory result ; 



292 APPENDIX. 

we know that it is the action of the nerves and minute blood- 
vessels, that made the stricture, by keeping alive the irritation 
and inflammation, thus thickening the membrane hning the 
urethra, and gradually closing it up. 

When you shall have read the authors on stricture for the 
past fifty years, you will learn that it is not extravagant to 
say that their treatment for its radical cure is entirely worth- 
less and absurd. Mr. Syme, of Edinburgh, within the past 
fifteen years has changed all our ideas, and created the thera- 
peutics of stricture. The canny old Scot has left us nowhere. 
Palmam qui meruit is our motto. 

EXAMPLES OF STRICTURE. 

Case First.— Complete obstruction, of two days duration, 
from irritable stricture. Entering my office some time after 
the evening hour, I found several persons in waiting ; recog- 
nizing an interesting case in which I had divided a stricture 
the previous week, I was making some inquiries regarding its 
progress, when a groan reached my ears, from a young man 
who had come attended by his physician. I immediately 
noticed he had that peculiar expression of countenance that 
indicates what accoucheurs call a "bearing-down," or labor 
pain, such as that which accompanies the commencement of 
the last or expulsive stage of parturition. The bladder occu- 
pies the same region, and is governed by nerves from the 
same part of the spinal marrow that the womb is ; and the ef- 
fort to expel the urine retained for two days, will produce pre- 
cisely, so far as the face and abdominal muscles are concerned, 
the aclion~o£ parturition ; without relief, this would go on until 
the bladder burst, when death would soon follow from the 
effusion of urine, causing inflammation in the abdomen. This 
young man was about thirty years of age. He had had gon- 
orrhea or clap for a long while, several years before : yet he 
was married since, and had one child. He presented me a 



APPENDIX. 293 

note from a friend, to this effect : " This man has a had stric- 
ture. We, (two gentlemen, his friends) have been at him, off 
and on, for two days ; we can not pass the smallest bougie or 
catheter. Try what you can do with your new instrument." 
Although this case was sent to me so frankly, most surgeons 
will agree with me, that I had no cause to be thankful for. 
having thus thrust upon me the awful responsibility of a man 
who had been unsuccessfully treated for two days, and actual- 
ly had pains on him preparatory to the bursting of his blad- 
der ! I am obliged to state the case in this way, to show how 
far gentlemen will deem themselves justifiable in proceeding, 
where three have been in consultation, and where it is only 
human nature to suppose that one, at least, considers himself 
competent, perhaps skillful. The reader will perceive, that in 
the event of failure in relieving the man by passing the cathe- 
ter, I should have been obliged to operate on him at once in 
my own house, or send him to my hospital. I say candidly, 
that I believe this latter was the intention, and I think it but 
fair to say to gentlemen who meditate such acts of kindness, I 
shall not be thankful for their fruition. The medical gentle- 
man who came with the patient, was a hospital pupil of Mr. 
Syme, of Edinburgh. Mr. Syme is the great advocate of the 
incision of stricture. On inquiring whether he had had any 
medical treatment, I was told that all that had been practica- 
ble had been done, except bleeding and the warm bath. This 
would have been the treatment, according to all precedent and 
authority, when I commenced practice, thirty-five years ago, 
and it would have relieved him, after it had half killed and 
prostrated him for weeks, only to be renewed on the next oc- 
curence of cold feet, or slight debauch. My second question, 
" Have vou had ether or chloroform ?" was answered in the ne- 
gative. Seeing that the whole evil depended upon spasmodic 
action of the closing muscle of the bladder — a circular muscu- 
lar tissue, that closes the outlet or neck of the bladder like a 
ribbon, and that this spasm was excited by the stricture, render- 
ed more irritable by the unsuccessful use of the instruments in 



294 AITENDIX. 

so many hands—" drawing "blood freely," as I was told — I made 
no further effort till I had placed the patient under the full ac- 
tion of chloroform ; I prefer ether, but its slowness would not 
suit the urgency of the case ; I feared the bursting oi the blad- 
der. As soon as he was unconscious, I took a number six 
catheter, and passed it without the least difficulty, the urine 
issuing with such force as to pass over my shoulder, as I was 
kneeling on the floor by the side of the couch on which he 
lay. His relief was immediate and complete. 1 passed a num- 
ber ten catheter of gum elastic, and secured it with a bandage, 
the doctor suggesting it, and I being unwilling to risk the 
chance of his passing urine during the night, as he lived in 
Brooklyn. Having commenced this case, I was obliged, in 
justice, to finish it, as it created two enemies, out of the three 
gentlemen concerned in it — how justly, you may judge. The 
oldest of the three now laughs, and cites it as a case of their 
own stupidity ; but he has retired, and being a man of the 
world, can afford it. 

The patient could not endure the presence of the catheter 
longer than the next morning, which was what we both anti- 
cipated. The reader can judge of my surprise, when I again 
found him the next evening, this time unattended, in my 
office, unable to pass a drop of urine, the same efforts having 
been made by two of the gentlemen, unsuccessfuly, with no 
chloroform, to draw off the urine. The same treatment as 
before, was again successful. I sent him home with the catheter 
in his possession, and positive directions to stay in bed with all 
the clothing that he could pile on, warm bricks to his feet, and 
a teaspooniul of sweet spirits of nitre in a half-tumbler of flax- 
seed tea every two hours ; if that would not answer, a dee 
spoontul of laudanum in a wine-glass of starch, warm, to be 
thrown up the bowel ; in an hour the catheter number four to 
be gently tried under the cover, so as to avoid chill. If that did 
not answer, chloroform to be used, and number six tried, as I 
had. done, telling him frankly that he never would be cured, 
but constantly liable to just such attacks from cold feet, and 



APPENDIX. 205 

general chills, .to which he was constantly liable from his call- 
ing; — stoking up and supplying an engine — till the morbid 
action was for ever interrupted by dividing the stricture with 
the Urethrotome. I desired him to give my opinion frankly to 
the gentlemen, and not be unduly influenced by fear. He 
went home and required no further use of the catheter, or any 
treatment except the warmth in bed and the spirits of nitre, 
the stream, however, being smaller than before. The two 
gentlemen opposed the operation, assuring him that dilating 
the stricture would cure it, and the operation was unnecessary 
and unwarrantable. He had now lost all confidence in his 
advisers ; and at his request, a fortnight after his last visit, I 
divided the stricture in the presence of Dr. Henry, of this city. 
The other gentlemen were not invited, because they did not 
approve of the operation. The patient was etherized, although 
it is not nceessary ; there is no pain in the internal incision, 
and any case in which the smallest bougie can barely enter the 
stricture for a single line, can be divided, generally at the 
first attempt. He, however, desired the ether, and it was 
given in anticipation of spasms, as he had suffered so much. 
Immediately we placed a number twelve catheter in the blad- 
der, the full size of the urethra. Not a bad symptom followed. 
He w r as not confined an hour in bed, and in a week he resum- 
ed his employment, being directed to keep dry feet, body 
warm, live temperately, and introduce the catheter once a week 
for a few months. We have not seen him for nearly a year, 
but learn from several patients he has sent us, that he is in 
perfect health. 

This case illustrates a vast number ; it is by far the most 
frequent one we see ; its beginning, it did not even arrest the 
notice of the patient ; like a vast majority of cases, it commenced 
in an obstinate clap ; tl|p.t was the irritation that produced the 
inflammation, which finally made the stricture, in its most fre- 
quent place, an inch and a half from the bladder. The patient 
was perfectly temperate, but liable to chills and cold feet, tho 
greatest exciting causes of congestion and swelling of the 



293 APPENDIX. 

blood-vessels that form the lining- membrane of the urethra. 
A chill after great exertion, producing a sweat, occurred ; 
spasm of the muscles followed ; mechanical irritation was 
added from too long continued efforts to overcome the stricture 
by bougies ; no chloroform, the great relaxer of spasms, was 
used ; and nothing but relief could follow, even from that, 
had it been used ; there could be no cure, till the morbid con- 
dition was interrupted by dividing the stricture. How far it 
illustrates our ideas of the evil results of medical treatment, 
or of medical consultations, we leave others to determine. The 
patient has given leave to publish his case. He is in the em- 
ploy of Mr Secor, ship-builder, of South-Brooklyn. 

Case Secoxd. — Stricture by a bruise received by falling 
from a height on the edge of the tail of a wagon-box : A. W. 
S. Shippen, Cameron County, Pa., a young man of twenty- 
four, iron machinist. During some agricultural pursuit, this 
young man fell and alighted astride of the tail-board of a 
wagon, bruising the urethra and inducing the usual symptoms 
of stricture : gradual diminution of the stream, first, spiral 
form, and finally scattering of the stream of urine, often 
threatened with complete suppression from checked perspira- 
tion, during his laborious business. He was several years in 
this conditi >n, but contemplating marriage, and being a very 
conscientious and intelligent man, concluded to seek surgical 
advice. My journal, Tiie Scalpel, having fallen into his 
hands, he was induced to seek my aid ; a friend followed him 
to the train, and earnestly dissuading him from his rash con- 
clusion, assuring him he would meet his death from so awful 
a man, and that the New York surgeons in general were noth- 
ing but executioners. I found the stricture within a couple of 
inches of the bladder, or just where a person would alight in 
falling astride of a board ; a numbeHtwo steel sound would 
pass with difficulty. This, however, is ample for the Ureth- 
rotome. I could have divided at once, but yielded to his 
desire to have a little more opportunity to study his execu- 
tioner's habits. In about a week I used the Urethrotome sue- 



APPENDIX. 297 

cessfully, giving so little pain that be laughed at his apprehen- 
sions. In an other week he returned to his home, with several 
number twelve bougies, which he was directed to use occasion- 
ally. 1 gave him a stock, because I believe strictures arising from 
kicks, or bruises, must become ulcerated when the injury 
was inflicted, and that the urethra can only be preserved 
through the contracted cicatrix, in a very irregular form. Our in- 
cision, therefore, forms a new passage in one or two points of its 
course, not enlarging the old simply. Therefore it will take 
longer to re-establish it of a full size, and allow the whole to 
be covered by a newly-formed mucous membrane. Nature 
does not yield so fast in irregular ulceration. These, we have 
explained, contract, because they ulcerate. Such cases, are, 
however, rare : we have had several from kicks — this one is a 
type of most cases of stricture from a bruise. 

Case Third. — A young man who had indulged during 
several years in self-abuse, became so exhausted from seminal 
emissions, that he applied to a very notorious operator of this 
city for treatment. He proposed cauterization with Lalle- 
mand's instrument. This was repeated no less than twelve 
times, at intervals of a week. I can only suppose, that the 
instrument was used for deception, and for nine or ten times 
either very slightly, or not at all charged with caustic, as I can 
not conceive the possibility of its having been used weekly ; 
if charged and used in the manner directed by Lallemand, in 
his book — the urethra would have been ulcerated and complete- 
ly closed by the fifth time. I have never myself used the in- 
strument of Lallemand, though I have for years followed his 
book as a guide in such cases. We owe him all that we really 
know of the principle of cauterization, and although I have 
seen the instrument invented by myself, described in the thirty- 
sixth volume of the Boston Medical and Surgical Journal, extolled 
by Dr. Gross, in his great work on Diseases of the Urinary Or- 
gans, as " the only one proper to be used," I am obliged to say 
that I deem them both dangerous : Lallemand's, because it is 
quite impossible to use it without injuring the urethra ; my 



298 APPENDIX. 

own, because it frequently catches and tears the mucous mem- 
brane in the opening through which the caustic is applied 
when the charged caustic-holder is drawn back, previous 
to withdrawing the instrument. I would gladly withdraw it 
from the shops if I could, but such things, wh n given to the 
instrument-makers, tire beyond control ; they will make what- 
ever will sell ; surgeons of limited experience will use what- 
ever they think promises well ; and the patient suffers. I now 
use a much simpler one, which I will presently describe. 

I luive never seen a worse case of stricture than this one. 
All the trouble originated after the tenth application ; the 
twelfth completed the stricture. The patient passed blood and 
matter for several weeks, he urinated with great pain, and the 
only reason, in my opinion, why he did not have on opening 
from ulceration in the urethra, and a urinary fistula from the 
violence of the information, was simply because the injury in- 
flicted was at the neck of the bladder. Had there been a space 
of two inches, as in many case- of stricture from clap, the pres" 
sure of the urine would have caused ulceration in the urethra, 
and the patient would have had fistulous opening between his 
legs, or, as surgeons say, in the perinaeum. 

1 could in this case introduce no instrument whatever ; the 
contraction was so extensive and so dense, that 1 was obliged 
to use the Urethr tome, without the director, which, in ordinary 
ruses, enters the stricture and acts as an avmit eourrier. I used 
the instrument that is made with the full curve of the 
urethra in its undiseased state, and projected tin; blade line by 
line. The stricture was a full inch in length. I succeeded in 
cutting through it, alter ten or twelve projections of the blade ; 
as soon as the blade met no more resistance, I passed a num- 
ber ten catheter into the bladder. The patient remained a 
fortnight, by which time I had taught him to pass the gum 
elastic catheter with ease. He has since married, and is ap- 
parently contented. He has, however, no children, and the seat 
of the injury, involving the seminal ducts, I think it probable he 
is impotent. I am inclined to think the observations made in 



AprENDix. 299 

my work on Diseases of the Sexual System, were richly 
merited by this dangerous instrument. How far any instru- 
ment would be sate in the hands of some of our practitioners, 
I leave my professional brethren to j udge, when I was told by 
a celebrated Professor he used it every fourth day ! Caustic 
is certainly a very powerful agent, and although the practical 
surgeon can not possibly dispense with it in an infinite variety 
of sluggish and irritable ulcers, and in passive spermatorrhea, 
it must always be used with great care ; in the latter disease 
never nearer than a fortnight between the applications, and 
never applied over four times to any one case. I now use the 
simple catheter, with its point cut off, and a pyriform-headed 
gutta-percha bougie inclosed in it. The caustic is attached to 
one inch of the bougie, directly behind the head, by means of 
melted wax painted lightly over that one inch ; it must first 
be powdered very finely, and the waxed end of the bougie 
rolled round in a fold of paper containing the caustic, and 
pressed on the wax by the thumb and forefinger. When 
properly charged, the caustic should show the bougie, or rather 
the wax, distinctly through it : it should only be barely 
whitened with the caustic. Immediately before it is passed 
into the urethra, the patient should pass his last drop of water 
from the bladder. If he does not do this with absolute 
thoroughness, the urine will enter the catheter and completely 
neutralize the caustic, rendering that application perfectly 
useless ; indeed, it will be quite useless, should any urine issue 
from the catheter, to draw it back and expose the bougie 
to the seminal ducts, because there will be no caustic on it. — 
Wait, in su*h an event, for three days, and direct the patient 
to use more care in passing his urne. 

It will sometimes happen, however, that there is a state of 
partial paralysis of the bladder, which renders it impossible to 
pass all the urine ; it will dribb:e for some time after the 
patient readjusts his clothing. The urethra will also become 
relaxed and baggy for a couple of inches from the neck of the 
bladder, forming a small bladder, as it were, out of the 



300 APPENDIX. 

urethra. This will often allow the stylet to be projected from 
the catheter, and the surgeon will feel -no resistance; the 
instrument will often indeed pass directly into the bladder, 
with no resistance from the sphincter or closing muscle, as 
is usual in healthy people. These are the worst kind of cases 
and will admit of a much freer use of the caustic. Strychnine 
is useful in such cases ; but this demands the careful 
attendance of the surgeon ; it would, perhaps, lead to mischief 
if we were to give any directions for its use. We take 
occasion to caution the surgeon in the use of our truncated 
caustic catheter, as now sold in the shops. If the stylet be 
made of whalebone, that substance becomes very brittle, 
if kept in a cold place ; it is likewise eaten by a peculiar 
insect. It would be a sad accident were the end to be broken 
off in the urethra or bladder. Mr. Tiemann now makes them 
of gutta-percha, which is perfectly safe, and far more flexible 
and easily introduced into the catheter. 

This instrument is now, 1 believe, more extensively used 
than any other caustic catheter. It was devised immediately 
after the one I have condemned, and is with the gutta-percha 
stylet, perfectly safe and absolutely certain to touch the ducts 
and the last inc'.i of the urethra, which is always involved in 
spermatorrhea. With Lallemand's instrument, aside from its 
mechanical defects, accuracy in the place of application of the 
caustic is impossible. 

We have now cited, out of a gr at number, three type-cases, 
illustrating the comprehensive character, as a curative instru- 
ment, of the Urethrotome. We should rather use the plural 
uumber, for there are six different instruments. The cases 
are purposely se ected from the most difficult ones. In every 
minor case of stricture, some one of the instruments is equally 
applicable. In cases of enlarged prostrate gland, whore the 
passage of the catheter is very difficult, there is no reason why 
the instrument should not prove equally effective. Our 
experience has been confined to two cases only ; in both, the 
ter number ten was passed, and the patients are still 



APPENDIX. 301 

quite comfortable whilst themselves using it. In neither case 
can a cure be anticipated, as both patients are advanced in life. 
Neither has ever been strict ured. 

In cases ol long-continued gleet, where stricture is beginning 
to form, the instrument will be found very effective as a 
resolver of local congestion. It operates precisely like the 
delicate divisions, made by the lancet, of the lining membrane 
of the eyelids. We have cured numerous cases of gleet, 
which had resisted the various applications in use by the 
bougie, after a few very slight incisions, scarcely tinging the 
urine with blood, and requiring no confinement nor any other 
treatment whatever ; the discharge, and sensitiveness of the 
urethra, have ceased in a fow weeks, and where a number four 
or six bougie would barely pass, with considerable pain, we 
have sent the patient away, able to pass number ten and 
twelve, with perfect ease and no pain whatever. In cases 
of great irritability of the neck of the bladder, doubtless pro- 
duced by backward continuation of morbid action from the 
stricture, great relief has followed. No doubt exists on my 
mind, if the unfortunate " business habits " of our exciteable 
people would allow them to take time to investigate the 
subject, most of these cases could be cured. They require, 
however, the presence of actual stricture, before most of them 
ean bring themselves to so great a sacrifice. When the urine 
is actually suppressed, then only does the patient perceive the 
necessity of positive surgical treatment. Out of many 
hundred cases of gleet, few have been told that a gleet is the 
first symptom of the formation of stricture. It is the almost 
invariable custom for all such cases to be placed under med- 
ical remedies, that is, remedies to be swallowed. These they 
can buy in any quantity, and unfortunately not always from 
quacks and apothecaries ; there is not a " respectable phy- 
sician " in this city who will not prescribe " remedies " for 
gleet as long as they are demanded, or, his patient will pay 
him for so doing. Not five per cent, are even sounded to 
ascertain whether there is not actual stricture. It is far easier 



302 APPENDIX. 

to write a receipt for medicine, and when the list is exhausted, 
or the patient has lost confidence in his physician, he goes to 
another, only to experience the same role, of disappointment. 
He finally becomes disgusted, and abandons himself to eaiing 
and drinking to keep up his waning powers, until actual stric- 
ture and partial less of virility warns liim to seek the surgeon. 
1 printed the opinion twelve years "jjo in my work op Diseases 
ot the Sexual System, that the medical treatment of gonorrhea 
and gleet was entirely empirical, und could never be other- 
wise. A " remedy" to he swallowed, with the view of produc- 
ing any certain action on the urethra, is absurd ; it may act 
favorably, but no reliance whatever can be placed upon it. It 
goes into the stomach, not into the urethra. The stomach 
first acts on it, and its indigestible portions pass out of the 
bowels ; but a very alight action from any remedy, however 
powerful, can be expected on any entirely disconnected cavity 
and its lining membrane. Moreover, it deranges the digestion, 
and the chief remedy relied on, the Balsam Copabia, itself of- 
ten produces a formidable eruption over the wl ole body and 
face, which insures the i xposure oi the ]-• tient as the probable 
victim of a far more formidable, indeed, an awful disease. Tin re 
are no scientific methods of treating elap but two: FJJ 
and on the appearance of the first symptom, meaning. th< i 
on the first hour of its appearance, by the local application of 
nitrate of silver by the means of a wax bougie very lightly 
charged ; this should never be :ns< rted more than an inch, for 
there the poison exists only. Injections are absurd, for 
they go entirely past the spot, and produce inflammation lower 
down, inviting the continuous action of the poison throughout 
the whole urethra. This method should never occupy over 
three days ; if then successful, the patient should starve him- 
self down, drink neither spirit s, war r. tea, nor coffee, on the 
principle of not filling the b d-vessels, and as soon as all in- 
flammation, as evinced by scalding on urinating, has ceased, ho 
may use injections, cither mineral or vegetable, to contract the 
relaxed membrane of the urethra, and aid the return of health- 



^srrENDTx. 003 

fill action. If the patient will not do this, niid keep liis foet 
and skin constantly warm, by staying in the house if neces- 
sary, or in bed, he may rely on on it that the disease will last 
from a month to a year, before it ceases naturally. In the lat- 
ter case, and if he be scrofulous, or a great smoker of tobacco, 
it may lea\ T e a gleet, or white discharge, which is the symptom 
of incipient stricture. This, gentleman, is the verdict of rvery 
scientific and honest man who has had experience enough to 
discover, and has manhood enough to speak, the truth. 

You may avail yourselves of the patient's ignorance and 
prejudice in selling him "a cure," but you will gain no last- 
ing professional character by following the general example of 
your medico-commercial brethren. Give your patient honest 
advice, and caution him against his indiscretions ; impress on 
him the necessity of keeping down inflammation for a fort- 
night,, and don't allow him to cheat you out oi your fee. He 
\\ ill learn to esteem you far more than though you pandered 
to his prejudices. 

Our next lecture will be on the sympathetic symptoms of 
the urethra, rectum, and uterus, in other parts of the body. 
We shall also consider the subject of difficult menstruation 
and sterility, showing the admirable adaptation of the 
Urethrotome to the cure of this pathological condition. In 
immediate connection with this subject, you will see illustrated 
the anatomy of the urethra, and vesicula seminal es, and the 
prostate gland and bladder ; also the gravid uterus for each 
month, and the anatomy of the pelvis of both sex* s. These 
exquisite works of art are the produce of the Florentine Acade- 
micians. I imported them expressly to illustrate these sub- 
jects, because it is impossible to show labor on the dead body. 
They will be invaluable when we come to speak of natural 
and difficult parturition. 

It shall not be my fault if I do not give you some in return 
for the sacrifice of time and money which has brought you 
from your homes, and your own medical and surgical pursuits, 
to see what you can gather from my humble table. Had you 



304 APPENDTX. 

taken the same step before yon obtained your diploma, you would 
not only have been rejected on your examination, whatever your 
attainments, but have been forever ostracized from your breth- 
ren. The Scalpel, and the independent course of its Editor, 
lu.ve been very far from securing him the amenities of his 
academic brethren, and the social delights of a yearly dinner, 
with the bSgh compliment to his intelligence of listening to 
a president who could not write his own language correctly. 
But these are the days of reform and rebellion. God grant 
that we may live to see the day when the people and our 
profession will learn that they have higher duties to perform 
than the formation of political and medical cliques, and the 
acquisition of money. We have aided in killing that infam- 
ous association, the Kappa Lambda Society, and we hope to 
live long enough to purify the Academy of Medicine. 

Note. — It is due to our self-respect to explain why these 
have not been drawn and described in the medical journals, 
like all our other instruments. During thirty-five years' prac- 
tice in this our native city, we have invented a greater 
number of instruments now in use, than any other member of 
the profession. If this be denied, we refer the matter to the 
surgical instrument-makers and to the Boston Medical and Sur- 
gical Journal. Our own Journal, The Scalpel, contains cuts 
of several. 

These instruments have been freely given to the profession. 
The community expresses surprise that professional men do 
not patent their instruments. This, of course, no man of right 
professional feeling would do. It is but human nature, 
however, where a man has devoted his whole time for thirty- 
fire yean to a profession, that he. should wish to derive some 
credit from his inventions, whilst still pursuing that profession 
practically. 

We will record two little incidents to show how far such a 
result is likely to happen. Dr. Samuel D. Gross, Professor of 
Surgery at Philadelphia, in his great Compendium of Diseases of 
the Sexual Organs, when treating on involuntary seminal emis- 



APPENDIX. 305 

sion, "has given an accurate cut and description of our 
caustic catheter (the one we have condemned and now cease 
to use), taken from our work on Diseases of the Sexual System, 
and after pronouncing it the only safe instrument for that 
purpose, omitted to name the inventor, though that very hook 
was presented to him by our own hand. The same gentleman ex- 
amining our six-branch speculum, described in The Scalpel, 
at Mr. Tiemann's shop in this city, denied that we were the 
inventor ! 

Our Uterine Bisector and Polypus Ligator, have both been 
shown and described for years to the surgical classes at 
the University in this city, and the name of the inventor 
never once mentioned, though we have presented the in- 
struments to the distinguished Professor, ( our own preceptor, 
Dr. Valentine Mott,) who has been President of the Medical 
Academy ! 

Is it necessary for us to say more ? Mr. Syme has been 
obliged to sue one of the most eminent surgeons of London for 
endeavoring, by detraction of his character, as a safe surgeon, 
to prevent his practising the very operation to avoid the ne- 
cessity for which we have invented these instruments, Mr. 
Synie's operation, though perfectly effectual, is really a severe 
one. If we have succeeded in adding a good contribution to 
the surgical armament, it will be none the less valuable when 
we have received that return which it is but reasonable to 
anticipate, and which, it would seem, is all we are likely 
to get. 

An experience of ten years since the invention and use of the 
instrument, then first described in a short essay published in 
1855, in the ninth edition of my book on Diseases of the 
Sexual System. We have republished that essay in this the 
tenth edition, because we wish to show how slowly and labor- 
iously we attained the truth, and how reliable a practical mea- 
sure it is. We are now convinced that the views therein ex- 
pressed are quite correct, but that the instrument will not an- 
swer for the worst cases of stricture. During a part of that 



J>OC» APPENDIX. 

period, -whilst in the pursuit of the object we then Lad in 
view, but. which we are now convinced was quite unattainable, 
namely, a single instrument sufficiently comprehensive in its 
adaptation to divide and dilate all cases of stricture, we have 
invented no less than six different instruments, all adapted to 
different complications of stricture. These we still designate 
by the general name of the Urethrotome. It is with the view 
of answering inquirers from abroad more comprehensively than 
we could possibly do by letter, that we have prepared tins 
short digest of a lecture on stricture prepared for our private 
class. 

We would suggest that a personal investigation is almost 
invariably necessary for a correct opinion ; we therefore con- 
scientiously advise personal application. If this be impossible, 
we must insist on the enclosure of our fee, ($5) — if the writer 
desires an answer to this letter. It would occupy our entire 
time, if we attempted to answer the litters we receive from 
those whose descriptions .are entirely inadequate to give any 
idea of their cases. We are usually obliged to ask for other 
symptoms, which they have overlooked, before we can give 
any assurance that treatment will be available ; this requires 
time, and we are obliged to charge for it, as we do for personal 
consultation. If any operation be advised, an accurate busi- 
ness arrangement must be made before the period appointed 
for its performance ; as we are frequently obliged to decline 
the terms offered— and are often absent from home. A week's 
notice by letter will prevent disappointment ; this had better be 
directed to our residence, 42 Fifth Avenue. If out of the city 
to box 3121. 



APPENDIX. 307 



Abridged from a Lecture on Irritable Urethra and its 
consequences. Delivered to his private Surgical 
Class, by Edward H. Dixon, M. D., Editor of The 
Scalpel, and Operating and Consulting Surgeon, 
42 Fifth Avenue. (Tenth Lecture?) 

Gentlemen : You have now had an opportunity to exam- 
ine the structure of the urethra and its appendages, and to see 
the application of my instruments on the dead and living body. 
You have noted the dimensions, structure, and distances of 
the passage, and the position in which strictures most frequent- 
ly occur. I shall, therefore, take it for granted, that you are 
capable of judging of the propriety of adopting the views of 
Mr. Syme, and comparing them with those of the various # 
authors on stricture, and of following me in what I have now 
to say on that most frequent and distressing of all affections, 
Irritable- Urethra, and incontinence of urine, with partial loss of 
virile power. 

You will find a vast number of such cases in country towns 
and isolated farm-houses, where the ordinary excitements of 
society and city life are not operative in diverting the mind 
from its too frequent resource, the cultivation of the sexual 
passion. The extent to which self-abuse is carried in our 
excitable nation is fearful to think of. Nearly twenty years 
have elapsed since the publication of my work on Diseases of 
the Sexual System, and after the immense experience you may 
easily imagine I have had in consequence of the circulation of 
more than one hundred thousand copies of that work, I can as- 
sure you that the views therein expressed of its influence on 
the mind and body are more than confirmed. I wrote that 
book from a conviction of its necessity after three year's at- 



308 APPENDIX. 

tendance as Surgeon to two of our largest institutions for 
young people, namely, the Deaf and Dumb Asylum and the 
House of Refuge. I visited all our prisons and poor-houses, 
and conversed with the principals of many boarding-schools. 
The result of my experience was the conviction expressed in 
that volume, that it was the master vice of our young people, 
and that its terrible consequences were by no means under- 
stood or appreciated by our best physicians. 

The sympathetic influence of hemorrhoids, fissures and ulcers 
of the rectum, and varicocele, in producirg irritability of the 
urethra, and want of contractile power in the closing muscle 
or sphincter of the bladder, has been the subject of one lecture, 
you will, therefore, always give the existence of either of 
these affections due consideration in the treatment. Depend 
upon it, if you overlook their existence, or take the patient's 
assurance of the soundness of his rectum, without a careful ex- 
amination with the speculum, you will frequently be mortified 
in your efforts to cure incontinence of urine ; you will find it 
often utterly intractable whilst either of these diseases exist. 
The respective parts all derive their nerves from the same 
portion of the spinal system, and all their diseases are mutual- 
ly associated and dependent. Tobacco has a very powerful in- 
fluence in producing irritable urethra and piles. I have given 
my views on this subject with those of the great surgeons, Mr. 
Lizars and Sir Benjamin Brodie, in the forty-fifth and forty- 
sixth Nob. of Tfie Scalpel. 

Let us now consider carefully the condition of a man with 
irritable urethra. What does it mean ? A certain portion, 
usually near the neck of the bladder, in which the two semi- 
nal vessels send their two ducts to open their mouths, has 
taken on a morbid sensitiveness ; if we could see its color in 
the living body, we would find it much redder than the natur- 
al state ; indeed, we know it must be so, because the great 
sentitiveness could not exist without a high degree of conges- 
tion or fullness of the blood-vessels that form and nourish the 
membrane. Observe, that when the sound, or catheter, reaches 



APPENDIX. 309 

the two last inches of the urethra, just before it enters the blad- 
der, the patient will always shrink. Sometimes this irritability 
extends over the whole urethra to the end of the penis. The 
testicles also share it : they are often as movable as a bunch of 
earth-worms in a bag. 

The condition of the urethra may be produced by sexual ox- 
cesses as well as self abuse, and that most disgusting and£ 
unmanly practice — partial or incomplete sexual communica- 
tion ; a habit of our unfortunately ignorant young married 
people, to avoid or regulate offspring ; this practice, however, 
which I was about to call beastly, (but the poor beasts are too 
natural for such an act,) is often followed by loss of virility 
and by incontinence ; a passive condition, the reverse of irrita- 
bility : for this condition cauterization is used. I have spoken 
at length on the subject of cauterization, and you have the 
work of Monsieur Lallemand, its inventor and advocate. 
After a very large experience in its use, I have assured you 
that I have found it greatly overrated as a curative agent, 
besides being a very dangerous remedy and very likely to 
produce stricture in the hands of the empirics who use it so 
largely. It is only applicable to passive spermatorrhoea. 

Let us now consider the rationale of a remedy we use with 
great effect in several analogous conditions of other parts of 
the body : In ulceration of the rectum and fissure, where irrita- 
bility and exquisite pain exist on passing the stool, an instant 
cure is the result of a slight incision through the ulcer or fis- 
sure. In inflammation of the conjunctiva of the eye, instant 
relief follows the unloading of the vessels by drawing the lan- 
cet across them. In congestion of the lining membrane of the 
neck of the uterus, constituting painful menstruation, the 
the same result follows ; this is precisely analogous to the use 
of my urethratome for that purpose in the urethra : and now I 
want you in this immediate relation to follow me in the rea- 
soning I adopted in thus applying it with such admirable 
results, that 1 shall not readily discontinue it for the substitu- 
tion of medicines, which of course can only palliate for the 



310 APPENDIX. 

time they are given ; and how often will they do even that? 

When you pass a full-sized catheter — say number twelve 
— to ascertain the condition of the urethra, of course it you 
meet a bad stricture, you can go no further with that instru- 
ment ; suppose you try number six, and that goes 
though with difficulty, why, of course, you know that the 
man's urethra is obstructed to that extent, or one half its 
diameter. Now, if this condition exist, and he bo the subject 
of urethral irritation, either from clap or self-abuse, he is par- 
tially and for a time strictured— that is to say, he has a con- 
gestive and irritable stricture : surely so, for what else can you 
call it ? What is to prevent its becoming a permanent stric- 
ture? every stricture has a beginning. Is it not, therefore, 
evident to common-sense, that if you let the blood out of tho 
congested or engorged blood-vessels, and destroy the irritabil- 
ity of the nerves by dividing them, you will restore the nar- 
rowed urethra to its natural calibre, and stop the irritation of 
tin! nerves by dividing the tissues, as we do for congestion of 
the womb, lining of the eyelid, and the rectum ? And that is 
precisely the result. The patient has immediate relief by a 
couple of slight incisions that scarcely tinge the urine with 
blood ; a number twelve catheter will instantly pass with lit- 
tle or no pain ; he will pass his urine in a full stream ; and 
after a few times using the catheter, if he will follow other ra- 
tional directions, he will be cured of a very sad and humili- 
ating condition, and in all probability a permanent stricture, and 
perhaps partial or complete loss of his virility be prevented. 
The first example I presented you iu the Lecture on Stricture, 
fully illustrates this. 

It is this irritable and partially-inflamed condition of the 
urethra, gradually carried backwards to the closing muscle or 
sphincter of the bladder, that exhausts the contractile power of 
that muscle. The irritation of the urethra goads the bladder 
to contract, and the muscle loses its healthful organic or tonic 
power ; it is wearied out ; it is no longer subject to the will, 
but contracts and expands spasmodically and the urine issues 



APPENDIX. 3 1 1 

in drops unexpectedly. Any sudden agitation, such as fear, 
anger, or sexual desire by lascivious dreams, or unexpected 
proximity to the other sex, will often extend this spasmodic 
action to the muscles which envelope the membranous portion 
of the urethra and control the semen ; the contract ilu power 
of the seminal ducts is also impaired, and mortifying and pre- 
mature discbarges of semen occur in intercourse or in dreams. 
When this condition has continued a longer or shorter time, 
according to the power of the constitution of the patient, ;t 
passes into that painful and pitiful condition of passive loss 
of semen, in which he is quito unconscious of any sexual emo- 
tion ; the passage of the stools will cause its loss, and unless 
stopped, and -the constitution improved, the patient will pass 
into a decline or into the condition of fatuity — useless to him- 
self, and a nuisance to all about him. 

This condition is no longer irritable irritation, for that word 
implies action. The whole mucous membrane becomes blanch- 
ed and comparatively bloodless, and passive spermatorrhoea is 
established ; these cases require cauterization. 

Ali those who apply to you in this condition for relief, will 
demand medicine. I have for twenty years received on an 
average over a thousand letters a year, complaining bit- 
terly of the villainy of empirics who had deluded 
the writers with promises to cure them, and yet any one 
of them would have gladly swallowed more from my 
hands. The truth is, these poor people become desperate, 
crazed ; they see the difference between themselves and other 
men, and hav'ng no knowledge of the laws of their sexual and 
organic nature, they have no reason to doubt any promise that 
may be made them. One miserable individual has actually 
made thousands believe by his advertisements that there is a 
great philanthropic college in Philadelphia, to issue advice and 
make medicines lor their relief. Here, we have the dear old 
clergyman, whose "sands of life are nearly run," and who 
lias made a very large fortune, and is now in lusty youth 
engaged in stock and property operations in Wall street. He 
has been pointed out to me several times in the street. 

Neither Lupuline, Ergotine, Gelsemine, Tincture of Iron, 
nor any other medicines have any permanent effect. Bromide 
of Poass is now the newly proposed remedy. I am now using 
it, but I confess with little faith. There is only one tonic 
which will o-ive any increase of power to the system, and that 
is Phosphoric Acid, combined with Strychnine ; that medicine 
will, by adding to the exhausted nerves one of the greatest 
elements of their composition, produce the well-known effect 



312 



APPENDIX. 



of a fish diet, which is remarkable for its restorative effect on 
the jaded libertine. 

The Strychnine, you know, is the most direct excitant of the 
nerves known to physicians. Neither of these medicines, how- 
ever, will '• cure " the disease. They can only raise the physi- 
cal condition. When a libertine is nearly exhausted, and "has 
partially h>st his virility from sexual excess and smoking, and 
complains of coldness of the sexual organs, and dizziness, 
ringing of the ears, susceptibility to cold, and g>-n.'ral exhaus- 
tion, it is the best tonic you can give him, and will often 
induce him to believe he is getting well, and may resume his 
excesses. When the sphincter muscle of the bladder is 
weakened, and his urine dribbles from him, or he is exhausted 
from hemorrhoids, fistula, or prolapsus of the rectum, or if 
woman, the womb, it will greatly benefit most cases. Of 
course you must use the greatest care in its apportionment, 
nor should it ever be received from any hand but one of per- 
fect reliability. 

The Phosphoric Acid of the shops is quite unreliable ; much 
of it is doubtless pure water. You know the sources whence 
it is to be obtained, and must be quite sure of its quality. 

Bfon. — This Lecture has been printed with the object of 
giving a more satisfactory answer than his time could possibly 
allow, to those who are constantly addressing Dr. D. by letter. 
He has not the slightest faith in any medicine he has ever 

tried and he has tried most of them repeatedly — to "cure" 

the disease. With this avowal, he trusts all will be satisfied. 
Letters requiring advice must contain the usual tee of Five 
Dollars ; advice, however, is rarely of any value ; the patient 
should, if possible, make personal application. His disease re- 
quires an instrumental examination, both of the urethra and 
rectum. 

No. 46 of The ScArEr, contains a valuable article on the sub- 
ject of diseases of the, rectum, bladder, and uretus, and impo- 
tence and irritable urethra. It will greatly aid in forming a 
correct opinion. Enclose 50 cents to box 3121. 






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